Marchiori Silvano, Cousin François, Papadopoulos Iraklis, Bernard Claire, Thys Marie, De Prijck Bernard, Pirotte Michelle, Donneau Anne-Françoise, Hustinx Roland, Caers Jo, Withofs Nadia
Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Liège, Belgium.
Biostatistics and Research Methods Center (B-STAT), University of Liege, Liège, Belgium.
EJNMMI Res. 2024 May 28;14(1):51. doi: 10.1186/s13550-024-01113-6.
2-[F]fluoro-2-deoxy-D-glucose ([F]FDG) positron emission tomography combined with low-dose computed tomography (PET/CT) can be used at diagnosis to identify myeloma-defining events and also provides prognostic factors. The aim of this study was to assess the prognostic significance of baseline [F]FDG PET/CT visual IMPeTUs (Italian myeloma criteria for PET Use)-based parameters and/or total metabolic tumor volume (TMTV) in a single-center population of patients with newly diagnosed multiple myeloma (NDMM) eligible for transplantation.
Patients with MM who underwent a baseline [F]FDG PET/CT were retrospectively selected from a large internal database of the University Hospital of Liege (Liege, Belgium). Initially, all PET/CT images were visually analyzed using IMPeTUs criteria, followed by delineation of TMTV using a semi-automatic lesion delineation workflow, including [F]FDG-positive MM focal lesions (FL) with an absolute SUV threshold set at 4.0. In a first step, to ensure PET/CT scans accurate reporting, the agreement between two nuclear medicine physicians with distinct experience was assessed. In the second step, univariable and multivariable analyses were conducted to determine the prognostic significance of [F]FDG PET/CT parameters on progression free survival (PFS) and overall survival (OS), respectively.
A total of 40 patients with NDMM were included in the study. The observers agreement in the analysis [18F]FDG PET/CT images was substantial for the presence of spine FL, extra spine FL, at least one fracture and paramedullary disease (Cohen's kappa 0.79, 0.87, 0.75 and 0.64, respectively). For the presence of skull FL and extramedullary disease the agreement was moderate (Cohen's kappa 0.56 and 0.53, respectively). Among [F]FDG PET/CT parameters, a high number of delineated volumes of interest (VOI) using the SUV4.0 threshold was the only independent prognostic factor associated with PFS [HR (95% CI): 1.03 (1.004-1.05), P = 0.019] while a high number of FL (n > 10; F group 4) was the only independent prognostic factor associated with OS [HR (95% CI): 19.10 (1.90-191.95), P = 0.01].
Our work confirms the reproducibility IMPeTUs criteria. Furthermore, it demonstrates that a high number of FL (n > 10; IMPeTUs F group 4), reflecting a high [F]FDG-avid tumor burden, is an independent prognostic factor for OS. The prognostic value of the TMTV delineated using a SUV4.0 threshold was not significant. Nevertheless, the count of delineated [F]FDG-avid lesions VOI using a SUV4.0 threshold was an independent prognostic factor for PFS.
2-[F]氟-2-脱氧-D-葡萄糖（[F]FDG）正电子发射断层扫描联合低剂量计算机断层扫描（PET/CT）可用于诊断以识别骨髓瘤定义事件，还能提供预后因素。本研究旨在评估基于基线[F]FDG PET/CT视觉IMPeTUs（意大利PET在骨髓瘤中的应用标准）的参数和/或总代谢肿瘤体积（TMTV）在适合移植的新诊断多发性骨髓瘤（NDMM）单中心患者群体中的预后意义。
从列日大学医院（比利时列日）的大型内部数据库中回顾性选取接受基线[F]FDG PET/CT检查的MM患者。最初，所有PET/CT图像均按照IMPeTUs标准进行视觉分析，随后使用半自动病变勾画流程勾画TMTV，包括绝对SUV阈值设定为4.0的[F]FDG阳性MM局灶性病变（FL）。第一步，为确保PET/CT扫描报告准确，评估了两位经验不同的核医学医师之间的一致性。第二步，分别进行单变量和多变量分析，以确定[F]FDG PET/CT参数对无进展生存期（PFS）和总生存期（OS）的预后意义。
本研究共纳入40例NDMM患者。观察者对[18F]FDG PET/CT图像分析中脊柱FL、脊柱外FL、至少一处骨折和髓旁疾病的存在情况一致性较高（Cohen's kappa分别为0.79、0.87、0.75和0.64）。对于颅骨FL和髓外疾病的存在情况，一致性为中等（Cohen's kappa分别为0.56和0.53）。在[F]FDG PET/CT参数中，使用SUV4.0阈值勾画的感兴趣体积（VOI）数量较多是与PFS相关的唯一独立预后因素[风险比（95%置信区间）：1.03（1.004 - 1.05），P = 0.019]，而FL数量较多（n > 10；F组4）是与OS相关的唯一独立预后因素[风险比（95%置信区间）：19.10（1.90 - 191.95），P = 0.01]。
我们的研究证实了IMPeTUs标准的可重复性。此外，研究表明，FL数量较多（n > 10；IMPeTUs F组4）反映了较高的[F]FDG摄取肿瘤负荷，是OS的独立预后因素。使用SUV4.0阈值勾画的TMTV的预后价值不显著。然而，使用SUV4.0阈值勾画的[F]FDG摄取病变VOI数量是PFS的独立预后因素。
