PET/CT studies of multiple myeloma using 18F-FDG and 18F-NaF: comparison of distribution patterns and tracers' pharmacokinetics
PET/CT studies of multiple myeloma using 18F-FDG and 18F-NaF: comparison of distribution patterns and tracers' pharmacokinetics
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DOI：
10.1007/s00259-014-2721-y
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发表时间：
2014-07-01
影响因子：
9.1
通讯作者：
Dimitrakopoulou-Strauss, Antonia
中科院分区：
文献类型：
--
作者：
Sachpekidis, Christos;Goldschmidt, Hartmut;Dimitrakopoulou-Strauss, Antonia
目的评价18氟脱氧葡萄糖（18 F-FDG）和18氟氟化钠（18 F-NaF）PET/CT联合应用在多发性骨髓瘤（MM）患者骨骼评估中的价值，并比较两种PET示踪剂对MM的诊断价值。患者和方法该研究包括60名根据标准诊断的多发性骨髓瘤（MM）患者。所有患者均接受了动态（dPET/CT）骨盆扫描以及两种示踪剂的全身PET/CT研究。两次考试间隔一天。局灶性（18）F-FDG摄取增加的部位被认为是骨髓瘤累及的高度可疑部位。然后将（18）F-NaF PET/CT扫描检测到的病变与（18）F-FDG PET/CT检测到的病变相关联，后者作为参考。此外，（18）F-FDG PET/CT结果也与低剂量CT结果相关。dPET/CT研究的评价基于定性评价、SUV计算和基于2-组织房室模型和非房室方法的定量分析。结果全身（18）F-FDG PET/CT显示约343个局灶性病变，而（18）F-NaF PET/CT显示135个MM指示性病变（39%相关性）。CT显示150个病灶与（18）F-FDG PET/CT中的病灶相关（44%相关性）。6例患者表现为弥漫性的疾病模式与（18）F-FDG，而他们中的15人有一个混合（弥漫性和局灶性）模式的骨骼（18）F-FDG摄取。（18）F-NaF PET/CT检测到大量退行性、创伤性和关节炎性病变。在3例多灶性（18）F-FDG摄取的患者中，（18）F-NaF PET/CT未能显示任何骨病变。用（18）F-FDG和（18）F-NaF对骨盆区域进行dPET/CT扫描，分别显示77个和24个MM指示性病变。（18）F-FDG的动力学分析表明：SUVaver = 5.1，k（1）= 0.37（1/min），k（3）= 0.10（1/min），V-B = 0.06，内流= 0.04（1/min），FD = 1.28;（18）F-NaF的相应值为SUVaverage = 10.7，k（1）= 0.25（1/min），k（3）= 0.34（1/min），V-B = 0.02，流入量= 0.10（1/min），FD = 1.37。除~（18）F-FDG的V-B与~（18）F-NaF的k（1）相关（r = 0.54）外，其它动力学参数间无显著相关性。（18）F-FDG的FD与SUVaverage（r = 0.93）、FD与SUVmax（r = 0.80）、FD与内流（r = 0.85）、内流与SUVaverage（r = 0.74）均呈显著相关。在（18）F-NaF中，FD与SUVaverage（r = 0.97）、FD与SUVmax（r = 0.87）、内流与k（1）（r = 0.72）之间的相关性最显著。结论（18）F-FDGPET/CT和（18）F-NaFPET/CT的联合应用提供了有关MM骨病变生物学过程的不同分子信息。(18)在多发性骨髓瘤骨骼评估中，F-FDG PET/CT被证明是比（18）F-NaF PET/CT更特异的生物标志物。
Objective The aim of this prospective study is to evaluate the combined use of fluorine-18 fluorodeoxyglucose ((18) F-FDG) and fluorine-18 sodium fluoride ((18) F-NaF) PET/CT in the skeletal assessment of patients with multiple myeloma (MM) and to compare the efficacy of these two PET tracers regarding detection of myeloma-indicative osseous lesions.Patients and methods The study includes 60 patients with multiple myeloma (MM) diagnosed according to standard criteria. All patients underwent dynamic (dPET/CT) scanning of the pelvis as well as whole body PET/CT studies with both tracers. The interval between the two exams was one day. Sites of focal increased (18) F-FDG uptake were considered as highly suspicious of myelomatous involvement. The lesions detected on the (18) F-NaF PET/CT scans were then correlated with those detected on (18) F-FDG PET/CT, which served as a reference. Moreover, the (18) F-FDG PET/CT results were also correlated with the low-dose CT findings. The evaluation of dPET/CT studies was based on qualitative evaluation, SUV calculation, and quantitative analysis based on a 2-tissue compartment model and a non-compartmental approach.Results Whole body (18) F-FDG PET/CT revealed approximately 343 focal lesions while (18) F-NaF PET/CT revealed 135 MM-indicative lesions (39 % correlation). CT demonstrated 150 lesions that correlated with those in (18) F-FDG PET/CT (44 % correlation). Six patients demonstrated a diffuse pattern of disease with (18) F-FDG, while 15 of them had a mixed (diffuse and focal) pattern of skeletal (18) F-FDG uptake. A high number of degenerative, traumatic and arthritic disease lesions were detected with (18) F-NaF PET/CT. In three patients with multiple focal (18) F-FDG-uptake, (18) F-NaF PET/CT failed to demonstrate any bone lesion. The dPET/CT scanning of the pelvic area with (18) F-FDG and (18) F-NaF revealed 77 and 24 MM-indicative lesions, respectively. Kinetic analysis of (18) F-FDG revealed the following mean values: SUVaver = 5.1, k(1) = 0.37 (1/min), k(3) = 0.10 (1/min), V-B = 0.06, influx = 0.04 (1/min), FD = 1.28; the respective values for (18) F-NaF were SUVaverage = 10.7, k(1) = 0.25 (1/min), k(3) = 0.34 (1/min), V-B = 0.02, influx = 0.10 (1/min), FD = 1.37. Apart from the correlation between V-B of (18) F-FDG and k(1) of (18) F-NaF (r = 0.54), no other significant correlation was observed between the two tracers' kinetic parameters. We found a significant correlation between FD and SUVaverage (r = 0.93), FD and SUVmax (r = 0.80), FD and influx ( r = 0.85), as well as between influx and SUVaverage (r = 0.74) for (18) F-FDG. In (18) F-NaF we observed the most significant correlations between FD and SUVaverage (r = 0.97), FD and SUVmax (r = 0.87), and between influx and k(1) (r = 0.72).Conclusion The combined use of (18) F-FDG PET/CT and (18) F-NaF PET/CT provides different molecular information regarding the biological processes that take place in a MM osseous lesion. (18) F-FDG PET/CT proved to be a more specific biomarker than (18) F-NaF PET/CT in multiple myeloma skeletal assessment.