Multipl Myelomda Moleküler Görüntüleme
Özet
Kaya G., Molecular Imaging in Multiple Myeloma, Hacettepe University Faculty
of Medicine, Department of Nuclear Medicine, Thesis of Residency, Ankara,
2024. Multiple myeloma (MM) stands as the predominant primary malignancy of the
bone, characterized by plasma cell dyscrasia and resultant organ damage. The
assessment of disease involvement relies on a combination of clinical, laboratory and
imaging findings. Among various imaging modalities, F18 FDG PET/CT is commonly
recommended, although its sensitivity may be limited in specific case cohorts.
Consequently, the utilization of IMPeTUs criteria has been shown to enhance
examination sensitivity. Nonetheless, ongoing exploration of molecular agents seeks
alternatives with heightened sensitivity in disease assessment, notably choline-based
PET agents emerging as prominent candidates within molecular imaging
methodologies. Preliminary investigations with F18 Fluorocholine (FCH) PET/CT in
limited study cohorts have suggested superior diagnostic performance compared to
FDG. Our objective is to delineate the diagnostic efficacy of molecular imaging in
MM patients, refine imaging parameters, correlate methods with clinical and
laboratory findings and contribute novel insights to radiopharmaceutical literature,
particularly regarding agents like FCH anticipated for widespread accessibility in the
future. Hence, our study entails a comparative analysis of the diagnostic performances
of FDG and FCH examinations according to IMPeTUs criteria. Furthermore, we
investigate the associations between both imaging modalities and clinical as well as
laboratory parameters. For skeletal assessment, FCH demonstrated higher sensitivity
in both case-based and region-based analyses compared to FDG, exhibiting superior
performance. Evaluation of extramedullary disease (lymph nodes and soft tissue;
which has demonstrated prognostic significance), revealed equivalent performance for
both methods. While IMPeTUs recommendations proved adaptable to FCH, Deauville
3 yielded poor predictive value for assessing widespread bone marrow infiltration in
both tests. The study delved into imaging and clinical correlation, revealing a stronger
association between tumor burden and laboratory-clinical findings with FCH
compared to FDG. To refine the methodology, FCH imaging was conducted at two
time points and analysis indicated no significant disparity between images obtained at
the tenth and sixtieth minutes, suggesting that imaging at the tenth minute may suffice.
Moreover, considering the consistent observation of widespread disease in patients
with distal lower extremity lesions, it was concluded that inclusion of the distal lower
extremity in imaging protocols for every patient is unnecessary as a standard practice.
Conclusively, FCH emerges as a viable option in MM, particularly when FDG fails to
demonstrate metabolic activity or yields clinically inconclusive results and notably
excels in detecting minimal residual disease.
Keywords: Multiple myeloma, F18 FCH, F18 FDG, molecular imaging
