New imaging techniques have been introduced to assess the extent and severity of disease in multiple myeloma (MM) patients. The aim of our study was to compare newer imaging modalities - such as 18F-FDG PET/CT, 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy, and MRI - to assess their relative contribution in the evaluation of MM patients at diagnosis. Methods: Thirty-three newly diagnosed patients with MM were prospectively studied. Diagnosis and staging were made according to standard criteria. All patients underwent whole-body 18F-FDG PET/CT, whole-body 99mTc-MIBI, and MRI of the spine and pelvis within 10 d, and imaging findings were compared. Results: 18F-FDG PET/CT was positive in 32 patients (16 focal uptake, 3 diffuse uptake, 13 focal and diffuse uptake), 99mTc-MIBI was positive in 30 patients (6 focal, 11 diffuse, 13 focal and diffuse uptake), and MRI of the spine and pelvis was positive in 27 patients (6 focal, 13 diffuse, 8 focal and diffuse uptake). 18F-FDG PET/CT showed a total of 196 focal lesions (178 in bones and 18 in soft tissues), of which 121 were in districts other than the spine and pelvis, whereas 99mTc-MIBI visualized 63 focal lesions (60 in bones and 3 in soft tissues), of which 53 were in districts other than the spine and pelvis. In the spinal and pelvic regions, 18F-FDG PET/CT detected 75 focal lesions (35 in spine and 40 in pelvis), 99mTc-MIBI visualized 10 focal lesions (1 in spine and 9 in pelvis), and MRI detected 51 focal lesions (40 in spine and 11 in pelvis). Conclusion: In whole-body analysis, 18F-FDG PET/CT performed better than 99mTc-MIBI in the detection of focal lesions, whereas 99mTc-MIBI was superior in the visualization of diffuse disease. In the spine and pelvis, MRI was comparable to 18F-FDG PET/CT and 99mTc-MIBI in the detection of focal and diffuse disease, respectively. Because myelomatous lesions may often occur out of spinal and pelvic regions, MRI should be reserved to the evaluation of bone marrow involvement of these districts, whereas 18F-FDG PET/CT can significantly contribute to an accurate whole-body evaluation of MM patients. Finally, whole-body 99mTc-MIBI, despite its limited capacity in detecting focal lesions, may be an alternative option when a PET facility is not available.
- Multiple myeloma
ASJC Scopus subject areas
- Radiological and Ultrasound Technology