Division for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Dep. of Physics, University of Oslo, Oslo, Norway.
Mol Imaging Biol. 2022 Oct;24(5):842-851. doi: 10.1007/s11307-022-01734-0. Epub 2022 May 2.
[F]FDG PET/CT in multiple myeloma (MM) is currently the best technology to demonstrate patchy and extramedullary disease. However, [F]FDG PET has some limitations, and imaging with alternative tracers should be explored. In this study, we aimed to evaluate the performance of [F]fluciclovine PET compared to [F]FDG PET in newly diagnosed MM patients.
Thirteen newly diagnosed transplant eligible MM patients were imaged both with [F]FDG PET/CT and [F]fluciclovine PET/CT within 1 week in a prospective study. The subjects were visually assessed positive or negative for disease. The number of lesions and the SUV of selected lesions were measured for both tracers. Furthermore, tracer uptake ratios were obtained by dividing lesion SUV by blood or bone marrow SUV. Between-group differences and correlations were assessed with paired t-tests and Pearson tests. Bone marrow SUVs were compared to bone marrow plasma cell percentage in biopsy samples.
Nine subjects were assessed positively by [F]FDG PET (69%) and 12 positives by [F]fluciclovine PET (92%). All positive subjects had [F]fluciclovine scans that were qualitatively scored as easier to interpret visually than the [F]FDG scans. The number of lesions was also higher; seven of nine subjects with distinct hot spots on [F]fluciclovine PET had fewer or no visible lesions on [F]FDG PET. The mean lesion SUV values were 8.2 and 3.8 for [F]fluciclovine and [F]FDG, respectively. The mean tumour to blood values were 6.4 and 2.0 for [F]fluciclovine and [F]FDG, and the mean ratios between tumour and bone marrow were 2.1 and 1.5 for [F]fluciclovine and [F]FDG. The lesion SUV and ratios were significantly higher for [F]fluciclovine (all p < 0.01). Local [F]fluciclovine SUV or SUV values in os ilium and the percentage of plasma cells in bone marrow biopsies were linearly correlated (p = 0.048). There were no significant correlations between [F]FDG SUVs and plasma cells (p = 0.82).
Based on this pilot study, [F]fluciclovine is a promising tracer for MM. The visual and semi-quantitative evaluations indicate that [F]fluciclovine PET/CT can out-perform [F]FDG PET/CT at diagnosis.
在多发性骨髓瘤（MM）中，[F]FDG PET/CT 是目前显示斑片状和骨髓外疾病的最佳技术。然而，[F]FDG PET 存在一些局限性，应探索使用替代示踪剂进行成像。在这项研究中，我们旨在评估[F]fluciclovine PET 与[F]FDG PET 在新诊断的 MM 患者中的性能。
13 名符合移植条件的新诊断 MM 患者在一项前瞻性研究中，在 1 周内分别进行[F]FDG PET/CT 和[F]fluciclovine PET/CT 成像。对患者进行疾病阳性或阴性的视觉评估。为两种示踪剂测量选定病变的病变数量和 SUV。此外，通过将病变 SUV 除以血液或骨髓 SUV 获得示踪剂摄取比。使用配对 t 检验和 Pearson 检验评估组间差异和相关性。比较骨髓 SUV 与活检样本中骨髓浆细胞百分比。
9 名患者的[F]FDG PET 呈阳性（69%），12 名患者的[F]fluciclovine PET 呈阳性（92%）。所有阳性患者的[F]fluciclovine 扫描在视觉上更容易解释，优于[F]FDG 扫描。病变数量也更高；在[F]fluciclovine PET 上有七个九个明显热点的患者，在[F]FDG PET 上几乎没有或没有可见病变。[F]fluciclovine 和[F]FDG 的平均病变 SUV 值分别为 8.2 和 3.8。[F]fluciclovine 和[F]FDG 的肿瘤与血液的平均比值分别为 6.4 和 2.0，肿瘤与骨髓的平均比值分别为 2.1 和 1.5。[F]fluciclovine 的病变 SUV 和比值均显著高于[F]FDG（均 p<0.01）。局部[F]fluciclovine SUV 或髂骨 SUV 值与骨髓活检中浆细胞百分比呈线性相关（p=0.048）。[F]FDG SUV 与浆细胞之间无显著相关性（p=0.82）。
基于这项初步研究，[F]fluciclovine 是一种很有前途的 MM 示踪剂。视觉和半定量评估表明，[F]fluciclovine PET/CT 在诊断时可以优于[F]FDG PET/CT。
