Balleari E, Villa G, Garrè S, Ghirlanda P, Agnese G, Carletto M, Clavio M, Ferrando F, Gobbi M, Mariani G, Ghio R
Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, viale Benedetto XV 6, 16132 Genoa, Italy.
Haematologica. 2001 Jan;86(1):78-84.
Technetium-99m 2-methoxy-isobutyl-isonitrile ((99m)Tc-sestamibi) has recently been proposed as a potential tracer in patients with multiple myeloma (MM), as its increased uptake in the bone marrow has been reported as indicator of myeloma activity. We evaluated the role of (99m)Tc-sestamibi scintigraphy in the detection of myeloma bone disease in MM and related gammopathies, and also assessed its relationship with clinical status and stage of the disease, focusing in particular on the early follow-up of a small series of MM patients treated with high-dose therapy.
Forty-six consecutive patients affected by MM or monoclonal gammopathy of undefined significance (MGUS) were studied by whole body scans obtained 20 minutes after administration of 740 MBq of (99m)Tc-sestamibi. A semiquantitative uptake score was used and scintigraphic findings were correlated with clinical and laboratory data.
All the MGUS patients showed a negative (99m)Tc-sestamibi scan. Among the 32 MM patients (25 with active disease and 7 in clinical remission) 24 showed a positive scan, while 8 presented only a physiologic uptake of the tracer. The uptake score correlated significantly with all the most relevant clinical variables. In the follow-up of 8 MM patients treated with high-dose chemotherapy (99m)Tc-sestamibi closely paralleled the activity of myeloma bone disease. Comparison with X-ray skeletal survey showed discordant results in 14 out of the overall 56 scans obtained (27%), with 10 cases of negative (99m)Tc-sestamibi scans but lytic bone lesions revealed by X-ray (7 of them were in clinical remission), and 4 negative X-ray surveys in patients with positive (99m)Tc-sestamibi scans. Overall sensitivity and specificity of (99m)Tc-sestamibi scintigraphy in detecting myeloma bone disease were 90% and 88%, respectively.
This study provides additional evidence indicating that (99m)Tc-sestamibi scintigraphy closely reflects myeloma disease activity in bone marrow, with very high sensitivity and specificity. (99m)Tc-sestamibi scintigraphy is therefore suggested as a reliable new tool for the staging and follow-up of myeloma bone disease.
锝-99m甲氧基异丁基异腈（（99m）Tc-司他米比）最近被提议作为多发性骨髓瘤（MM）患者的一种潜在示踪剂，因为据报道其在骨髓中的摄取增加是骨髓瘤活性的指标。我们评估了（99m）Tc-司他米比闪烁扫描在MM及相关丙种球蛋白病中骨髓瘤骨病检测中的作用，并评估了其与疾病临床状态和分期的关系，并特别关注一小系列接受高剂量治疗的MM患者的早期随访情况。
对46例连续的MM或意义未明的单克隆丙种球蛋白病（MGUS）患者进行研究，在给予740MBq的（99m）Tc-司他米比后20分钟进行全身扫描。采用半定量摄取评分，并将闪烁扫描结果与临床和实验室数据相关联。
所有MGUS患者的（99m）Tc-司他米比扫描均为阴性。在32例MM患者中（25例疾病活动，7例临床缓解），24例扫描为阳性，而8例仅示踪剂生理性摄取。摄取评分与所有最相关的临床变量显著相关。在8例接受高剂量化疗的MM患者随访中，（99m）Tc-司他米比与骨髓瘤骨病活动密切平行。与X线骨骼检查比较，在总共56次扫描中有14次结果不一致（27%），10例（99m）Tc-司他米比扫描阴性但X线显示有溶骨性骨病变（其中7例临床缓解），4例（99m）Tc-司他米比扫描阳性患者X线检查阴性。（99m）Tc-司他米比闪烁扫描检测骨髓瘤骨病的总体敏感性和特异性分别为90%和88%。
本研究提供了更多证据表明，（99m）Tc-司他米比闪烁扫描能非常敏感和特异地密切反映骨髓中骨髓瘤疾病的活性。因此，建议将（99m）Tc-司他米比闪烁扫描作为骨髓瘤骨病分期和随访的可靠新工具。
