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J Nucl Med. 2008; 49 (Supplement 1):339P
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Oncology-Clinical Diagnosis: Hematologic Tumors

Hematology Malignancy

PET/CT and MRI in assessment of treatment response in patients (pts) with plasma cell myeloma

Henry Lin1, Melih Erkan1, Elgin Ozkan1, John Morgan1, Mounir Mikhaeil1, Fransico Viejo-Rullan1, Ali Mosavi1, Richard Libes1, Sundar Jagannath1 and Hussein Abdel-Dayem1

1 Saint Vincent's Hospital & Medical Center - Manhattan, New York, New York

1433

Objectives: Plasma cell myeloma (PCM) is the most common primary bone tumor. Although MRI is well suited for evaluating bone marrow process, the findings can be non-specific. Data is lacking in treatment monitoring utilizing hybrid FDG PET/CT.

Methods: FDG PET/CT and limited MRI (n=51) were performed in 25 PCM pts referred for evaluation of treatment response (ETR). MRI images were interpreted as positive for active PCM when lesions were hypointense on T1 weighted images, hyperintense on STIR and enhanced on Gad T1 weighted images. FDG PET/CT was considered positive based on increased FDG uptake corresponding to changes on CT. Findings were confirmed by lab data, bone marrow biopsy, exam and clinical follow-up.

Results: In the same body region, PET/CT and limited MRI identified 134 abnormal lesions: 33 concordant true positive (TP) and 110 discordant (9 TP, 101 false negative (FN)). 63.4% (64/101) of FN lesions measure ≤1 cm, which is below the resolution of PET. PET/CT reveals 92 additional TP lesions outside the field of view of MRI in 44% (11/25) of pts. In ETR by lesion analysis, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of PET/CT is 29.4%, 100%, 66%, 100% and 61% vs. 93.0%, 99.4%, 95.8%, 97% and 95% for MRI. However, patient based analysis reveals only one significant incorrect complete treatment response on PET/CT due to recent chemotherapy (4 days). PET/CT demonstrates 1 true partial and 1 complete response which was incorrectly characterized on MRI. MRI does demonstrate more lesions in 7 out of 25 pts and provides additional information of cord compression in 3 pts not apparent on PET/CT.

Conclusions: Our data suggest both PET/CT and MRI are complementary in ETR in PCM.





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Right arrow Articles by Abdel-Dayem, H.