Myslivecek M, Bacovský J, Scudla V, Koranda P, Minarík J, Buriánková E, Formánek R, Zapletalová J
III. interní klinika, FN a LF UP Olomouc.
Klin Onkol. 2010;23(5):325-31.
Newer imaging modalities, such as 18F-FDG PET/CT and 99mTc-MIBI scintigraphy, have been recently introduced to assess the activity and extent of disease in patients with multiple myeloma (MM) and gammopathy of undetermined significance (MGUS). The aim of our study was to compare the impact of these imaging modalities in the evaluation of MM and MGUS patients.
A total of 101 patients with MM (81 patients) and MGUS (20 patients) were enrolled in the study (21 newly diagnosed and 44 relapsed patients with symptomatic MM, 16 with asymptomatic MM and 20 with MGUS). All patients were without therapy and underwent 18F-FDG PET/CT and 99mTc-MIBI scintigraphy within a maximum interval of 14 days. The scans were classified as normal (N), diffuse (D), and focal or combined (F-FD) pattern.
There was no significant difference in the detection of newly diagnosed MM and relapsed patients between the compared methods. 18F-FDG PET/CT performed better than 99mTc-MIBI scintigraphy in the detection of focal lesions (p < 0.039), whereas 99mTc-MIBI scintigraphy was superior in the visualization of diffuse disease (p = 0.042). 18F-FDG PET/CT visualised significantly more focal lesions than 99mTc-MIBI scintigraphy (p = 0.002), both generally in the cohort and when comparing the number of focal lesions per patient. Both the imaging modalities singly or in combination influenced the subsequent clinical management in 17% of patients. In our study, 18F-FDG PET/CT predicted asymptomatic MM and MGUS transformation into more aggressive forms with the necessity to start therapy more often than 99mTc-MIBI scintigraphy.
18F-FDG PET/CT appeared to be a better imaging technique than 99mTc-MIBI scintigraphy in the detection of focal lesions in patients with symptomatic MM. 99mTc-MIBI was superior in the visualization of diffuse disease. On the other hand, despite its limited capacity in detecting focal lesions, 99mTc-MIBI scintigraphy still remains the most rapid and inexpensive technique for whole-body evaluation and may be an alternative option when a PET/CT facility is not available.
诸如18F-FDG PET/CT和99mTc-MIBI闪烁扫描术等新型成像方式最近已被用于评估多发性骨髓瘤（MM）和意义未明的单克隆丙种球蛋白病（MGUS）患者疾病的活性和范围。我们研究的目的是比较这些成像方式在评估MM和MGUS患者时的影响。
共有101例MM患者（81例）和MGUS患者（20例）纳入本研究（21例新诊断的有症状MM患者、44例复发的有症状MM患者、16例无症状MM患者和20例MGUS患者）。所有患者均未接受治疗，且在最长14天的间隔内接受了18F-FDG PET/CT和99mTc-MIBI闪烁扫描术。扫描结果分为正常（N）、弥漫性（D）以及局灶性或混合性（F-FD）模式。
在比较的方法之间，新诊断MM患者和复发患者的检测结果无显著差异。18F-FDG PET/CT在检测局灶性病变方面比99mTc-MIBI闪烁扫描术表现更好（p < 0.039），而99mTc-MIBI闪烁扫描术在显示弥漫性疾病方面更具优势（p = 0.042）。18F-FDG PET/CT显示的局灶性病变明显多于99mTc-MIBI闪烁扫描术（p = 0.002），总体上在队列中如此，在比较每位患者的局灶性病变数量时也是如此。两种成像方式单独或联合使用对17%的患者的后续临床管理产生了影响。在我们的研究中，18F-FDG PET/CT比99mTc-MIBI闪烁扫描术更常预测无症状MM和MGUS转变为更具侵袭性的形式，从而有必要开始治疗。
在检测有症状MM患者的局灶性病变方面，18F-FDG PET/CT似乎是比99mTc-MIBI闪烁扫描术更好的成像技术。99mTc-MIBI在显示弥漫性疾病方面更具优势。另一方面，尽管99mTc-MIBI闪烁扫描术在检测局灶性病变方面能力有限，但它仍然是全身评估最快速且最经济的技术，并且在没有PET/CT设备时可能是一种替代选择。
