Medicina Nucleare Metropolitana, Bld 30, AOU Policlinico S. Orsola-Malpighi, Via Massarenti, 9, 40138, Bologna, Italy.
Nuclear Medicine, IRCSS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia, Italy.
Eur J Nucl Med Mol Imaging. 2018 May;45(5):712-719. doi: 10.1007/s00259-017-3909-8. Epub 2017 Dec 21.
ᅟ: FDG PET/CT (F-fluoro-deoxy-glucose positron emission tomography/computed tomography) is a useful tool to image multiple myeloma (MM). However, simple and reproducible reporting criteria are still lacking and there is the need for harmonization. Recently, a group of Italian nuclear medicine experts defined new visual descriptive criteria (Italian Myeloma criteria for Pet Use: IMPeTUs) to standardize FDG PET/CT evaluation in MM patients. The aim of this study was to assess IMPeTUs reproducibility on a large prospective cohort of MM patients.
Patients affected by symptomatic MM who had performed an FDG PET/CT at baseline (PET0), after induction (PET-AI), and the end of treatment (PET-EoT) were prospectively enrolled in a multicenter trial (EMN02)(NCT01910987; MMY3033). After anonymization, PET images were uploaded in the web platform WIDEN® and hence distributed to five expert nuclear medicine reviewers for a blinded independent central review according to the IMPeTUs criteria. Consensus among reviewers was measured by the percentage of agreement and the Krippendorff's alpha. Furthermore, on a patient-based analysis, the concordance among all the reviewers in terms of positivity or negativity of the FDG PET/CT scan was tested for different thresholds of positivity (Deauville score (DS 2, 3, 4, 5) for the main parameters (bone marrow, focal score, extra-medullary disease).
Eighty-six patients (211 FDG PET/CT scans) were included in this analysis. Median patient age was 58 years (range, 35-66 years), 45% were male, 15% of them were in stage ISS (International Staging System) III, and 42% had high-risk cytogenetics. The percentage agreement was superior to 75% for all the time points, reaching 100% of agreement in assessing the presence skull lesions after therapy. Comparable results were obtained when the agreement analysis was performed using the Krippendorff's alpha coefficient, either in every single time point of scanning (PET0, PET-AI or PET-EoT) or overall for all the scans together. DS proved highly reproducible with the highest reproducibility for score 4.
IMPeTUs criteria proved highly reproducible and could therefore be considered as a base for harmonizing PET interpretation in multiple myeloma. A prospective clinical validation of IMPeTUs criteria is underway.
评估意大利骨髓瘤专家新定义的视觉描述标准（意大利骨髓瘤 PET 使用标准：IMPeTUs）在大量多发性骨髓瘤（MM）患者中的可重复性。
前瞻性纳入在基线（PET0）、诱导后（PET-AI）和治疗结束时（PET-EoT）进行 FDG PET/CT 的症状性 MM 患者进行 EMN02 多中心试验（NCT01910987；MMY3033）。在匿名化后，将 PET 图像上传到 WIDEN®网络平台，并根据 IMPeTUs 标准分发给五名独立的核医学专家进行盲法中心审查。通过一致性百分比和 Krippendorff 的 alpha 系数来衡量审查员之间的一致性。此外，在基于患者的分析中，对于不同的阳性标准（骨骼、局灶性评分、骨髓外疾病的 Deauville 评分 2、3、4、5），所有审查员在 FDG PET/CT 扫描的阳性或阴性方面的一致性进行了测试。
这项分析纳入了 86 名患者（211 次 FDG PET/CT 扫描）。中位患者年龄为 58 岁（范围 35-66 岁），45%为男性，15%处于国际分期系统（ISS）III 期，42%具有高危细胞遗传学特征。所有时间点的一致性百分比均优于 75%，在评估治疗后颅骨病变的存在时达到了 100%的一致性。当使用 Krippendorff 的 alpha 系数进行一致性分析时，在每次扫描（PET0、PET-AI 或 PET-EoT）的单个时间点或所有扫描的整体上均获得了类似的结果。Deauville 评分与 4 分具有最高的可重复性，因此具有高度的可重复性。
IMPeTUs 标准具有高度的可重复性，因此可以考虑将其作为多发性骨髓瘤中 PET 解释标准化的基础。目前正在进行 IMPeTUs 标准的前瞻性临床验证。
