Breyer Richard J, Mulligan Michael E, Smith Stacy E, Line Bruce R, Badros Ashraf Z
Department of Radiology, University of Maryland Medical Center, 22 South Greene St, Baltimore, MD 21201, USA.
Skeletal Radiol. 2006 Sep;35(9):632-40. doi: 10.1007/s00256-006-0127-z. Epub 2006 Jun 7.
To determine the usefulness of FDG PET/CT scanning in the management and staging of myeloma and to assess its strengths and limitations.
FDG PET/CT scans and all other available imaging studies were reviewed retrospectively from 16 consecutive patients by two experienced musculoskeletal radiologists and two nuclear medicine physicians working in consensus.
The 16 patients had undergone a total of 19 FDG PET/CT scans. Radiographs were available in all cases, including 13 skeletal surveys; 25 CT scans (16 chest, three abdominal, four pelvic, one spine, one neck) and 22 MR imaging studies (17 spine, three pelvic, two extremity) also were reviewed. Patients' records were examined for relevant clinical information. All focal areas of abnormal FDG uptake were correlated with the other imaging studies to determine clinical significance. FDG PET/CT scans also were reviewed to see if small lesions shown on the other imaging studies could be identified in retrospect.
The 12 men and four women had an average age of 58 years (range 30-69 years). All 16 patients had an established diagnosis of multiple myeloma, with average duration of disease, from time of initial diagnosis to review, of 30 months (range 6 months to 11+ years). The FDG PET/CT scans revealed a total of 104 sites (90 in bone, 14 soft tissue) that were suspicious for neoplastic activity based on a standardized uptake value (SUV) greater than 2.5. Fifty-seven of these sites (55%) were new or previously undetected. The other imaging studies (X-ray, CT, MR) and clinical information confirmed the other 47 areas but also revealed 133 other small skeletal lesions. Six of these 133 additional lesions showed mild FDG uptake on re-review of the PET/CT scans. The FDG PET/CT findings led to management changes in 9/16 patients. MR imaging revealed five cases of diffuse bone involvement (four spine, one scapula) that were not evident by FDG PET/CT.
FDG PET/CT scans are useful for the management and staging of myeloma. However, if PET/CT were the sole imaging study done, it would miss many additional small lytic skeletal lesions and could miss diffuse spine involvement.
确定氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（FDG PET/CT）在骨髓瘤管理和分期中的作用，并评估其优势和局限性。
两名经验丰富的肌肉骨骼放射科医生和两名核医学医生共同回顾性分析了16例连续患者的FDG PET/CT扫描及所有其他可用的影像学检查。
16例患者共进行了19次FDG PET/CT扫描。所有病例均有X线片，包括13次骨骼检查；还回顾了25次CT扫描（16次胸部、3次腹部、4次盆腔、1次脊柱、1次颈部）和22次磁共振成像（MRI）检查（17次脊柱、3次盆腔、2次四肢）。检查患者记录以获取相关临床信息。将所有FDG摄取异常的局灶性区域与其他影像学检查进行对比，以确定其临床意义。还回顾FDG PET/CT扫描，看能否回顾性识别出其他影像学检查显示的小病灶。
12名男性和4名女性，平均年龄58岁（范围30 - 69岁）。所有16例患者均确诊为多发性骨髓瘤，从初次诊断到复查的平均病程为30个月（范围6个月至11年以上）。基于标准化摄取值（SUV）大于2.5，FDG PET/CT扫描共发现104个可疑肿瘤活性部位（90个在骨骼，14个在软组织）。其中57个部位（55%）是新发现的或之前未被检测到的。其他影像学检查（X线、CT、MRI）和临床信息证实了另外47个区域，但还发现了133个其他小的骨骼病变。在复查PET/CT扫描时，这133个额外病变中有6个显示轻度FDG摄取。FDG PET/CT检查结果导致9/16例患者的治疗方案改变。MRI显示5例弥漫性骨受累（4例脊柱、1例肩胛骨），FDG PET/CT未显示。
FDG PET/CT扫描对骨髓瘤的管理和分期有用。然而，如果PET/CT是唯一进行的影像学检查，将会遗漏许多其他小的溶骨性骨骼病变，并且可能遗漏弥漫性脊柱受累情况。
