Department of Hematology, VU University Medical Center, Amsterdam, Netherlands.
Cancer. 2012 Apr 15;118(8):1971-81. doi: 10.1002/cncr.26467. Epub 2011 Sep 1.
The goal of this study was to conduct a comparative analysis of whole body X-ray (WBXR) and (18) F-fluoro-deoxyglucose positron emission tomography ((18) FDG PET) in staging and response assessment of multiple myeloma.
We performed a systematic review of studies comparing (18) FDG PET with WBXR and/or magnetic resonance imaging in terms of sensitivity for myeloma-related bone disease at staging and during follow-up.
Eighteen studies involving 798 patients met the inclusion criteria. The mean Quality Assessment of Diagnostic Accuracy Studies (QUADAS) score, expressed as a percentage of the maximum score, was 61%. In 7 studies (n = 242 patients), concordance assessment between WBXR and (18) FDG PET scan was possible, showing a higher sensitivity of the (18) FDG PET in the detection of myeloma bone lesions in 6 studies. The only study reporting on the prognostic value of (18) FDG PET at staging found that the number of FDG-avid focal lesions was an independent prognostic parameter. In addition, the limited studies on response monitoring showed that normalization of (18) FDG PET during treatment correlated with a superior clinical outcome.
In general, (18) FDG PET has a superior sensitivity for myeloma bone lesions compared with WBXR. Future studies have to validate the additive value of myeloma-related bone disease detected on (18) FDG PET-computed tomography (CT) in predicting outcome. Response monitoring with the use of (18) FDG PET-CT during treatment is promising, allowing more precise prediction of prognosis compared with the standard response monitoring. In view of the expanding treatment options for multiple myeloma, this may provide important information for treatment decisions in the future.
本研究旨在对全身 X 射线（WBXR）和（18）F-氟代脱氧葡萄糖正电子发射断层扫描（（18）FDG PET）在多发性骨髓瘤的分期和疗效评估中的作用进行比较分析。
我们对比较（18）FDG PET 与 WBXR 和/或磁共振成像在分期和随访期间对多发性骨髓瘤相关骨疾病的敏感性的研究进行了系统评价。
符合纳入标准的 18 项研究共纳入 798 例患者。以最大得分的百分比表示的平均诊断准确性研究质量评估（QUADAS）评分为 61%。在 7 项研究（n=242 例患者）中，WBXR 和（18）FDG PET 扫描之间的一致性评估是可能的，其中 6 项研究显示（18）FDG PET 检测多发性骨髓瘤骨病变的敏感性更高。唯一一项报告（18）FDG PET 分期预后价值的研究发现，FDG 摄取灶的数量是独立的预后参数。此外，关于疗效监测的有限研究表明，治疗期间（18）FDG PET 正常化与更好的临床结局相关。
总体而言，（18）FDG PET 对多发性骨髓瘤骨病变的敏感性优于 WBXR。未来的研究需要验证在（18）FDG PET-CT 上检测到的多发性骨髓瘤相关骨病对预测结局的附加价值。在治疗期间使用（18）FDG PET-CT 进行疗效监测具有很大的前景，与标准的疗效监测相比，它可以更准确地预测预后。鉴于多发性骨髓瘤的治疗选择不断扩大，这可能为未来的治疗决策提供重要信息。
