Prospective comparison of 18-FDG PET/CT and whole-body diffusion-weighted MRI in the assessment of multiple myeloma
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ORIGINAL ARTICLE
Prospective comparison of 18-FDG PET/CT and whole-body diffusion-weighted MRI in the assessment of multiple myeloma Charles Mesguich 1,2 Gerald Marit 2
&
Cyrille Hulin 3 & Valerie Latrabe 4 & Axelle Lascaux 3 & Laurence Bordenave 1 & Elif Hindié 1 &
Received: 28 January 2020 / Accepted: 7 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18FDG 18F-FDG PET-CT) are standard procedures for staging multiple myeloma (MM). Diffusion-weighted sequences applied to whole-body MRI (WB-DWI) improve its sensitivity. We compared the number of MM bone focal lesions (FLs) detected by 18 F-FDG PET-CT and WB-DWI and evaluated the diagnostic performance of 18F-FDG PET-CT for diffuse infiltration. Thirty newly diagnosed MM patients prospectively underwent 18F-FDG PET-CT and WB-DWI. The criteria for skeletal region positivity were ≥ 1 focal bone lesions (FLs) and/or diffuse disease. MRI with the MY-RADS criteria was used as a reference standard for the diagnosis of diffuse infiltration. 18F-FDG PET-CT and WB-DWI were both interpreted as positive in 28/30 patients with an agreement of 1.00 (95% CI 0.77–1.00) between the two methods. The mean numbers of FLs were 16.7 detected by 18F-FDG PET-CT and 23.9 detected by WB-DWI (P = 0.028). WB-DWI detected more FLs in the skull (P = 0.001) and spine (P = 0.006). Agreement assessed using the prevalence and bias-corrected kappa index was moderate (0.40–0.60) for the spine, sternum–ribs and upper limbs and substantial (0.60–0.80) for the pelvis and lower limbs. As regards the diagnosis of diffuse bone marrow infiltration, the sensitivity, specificity and accuracy of 18F-FDG PET-CT were 0.75, 0.79 and 0.77, respectively. Although WB-DWI detected more FLs than did 18F-FDG PET-CT, there was no difference in the detection of bone disease on a per-patient basis. 18F-FDG PET-CT showed high performance, including for evaluation of diffuse infiltration. Keywords Multiple myeloma . Magnetic resonance imaging . Diffusion magnetic resonance imaging . Fluorodeoxyglucose F18 . Positron emission tomography–computed tomography
Introduction Multiple myeloma (MM) is the second most common haematological malignancy with an annual incidence rate of 6 per 100,000 individuals worldwide [1]. Over the last decade, the median survival of MM patients has improved from 3 to 6 years due to the development of novel therapeutic approaches [2]. This has led to a paradigm change with a need for * Charles Mesguich [email protected] 1
Nuclear Medicine Department, CHU Bordeaux, 33000 Bordeaux, France
2
INSERM U1035, University of Bordeaux, Bordeaux, France
3
Haematology Department, CHU Bordeaux, 33000 Bordeaux, France
4
Radiology Department, CHU Bordeaux, 33000 Bordeaux, France
better prediction of prognosis and better assessment of response to therapies. Tumour burden at baseline is one of the main factors contributing to patient prognosis a
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