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Journal of Nuclear Medicine Vol. 47 No. 3 555a
© 2006 by Society of Nuclear Medicine

Use of 99mTc-Sestamibi Scintigraphy in Multiple Myeloma

Leonardo Pace, MD and Marco Salvatore, MD

Università degli Studi di Napoli Federico II Naples, Italy

Silvana Del Vecchio, MD

Istituto di Biostrutture e Bioimmagini–CNR Naples, Italy

TO THE EDITOR: We read with great interest the excellent review on imaging of malignant bone involvement by Einat Even-Sapir published in the August issue of The Journal of Nuclear Medicine (1). We would like to comment on the use of 99mTc-sestamibi in multiple myeloma. In recent years, different groups have reported a high accuracy for this tracer in the detection of active disease (2–7). In particular, 99mTc-sestamibi scintigraphy has shown a positive predictive value of 100% and a negative predictive value of 83% in the diagnosis of active multiple myeloma and a positive predictive value of 84% and a negative predictive value of 100% in identifying advanced stages (i.e., II or III) of disease (2). Positive 99mTc-sestamibi whole-body results were found in 30% of patients with no evidence of multiple myeloma on a radiologic full skeletal survey, and in the majority (76%), the scintigraphic findings agreed with the subsequent clinical follow-up (3). Moreover, there are consistent published data on the use of 99mTc-sestamibi in follow-up of patients with multiple myeloma (4–6). In particular, all patients with a negative 99mTc-sestamibi result at follow-up were actually in disease remission (either complete or partial), whereas 86% of those with a positive 99mTc-sestamibi result had disease progression (4). Even-Sapir expressed his concern about using 99mTc-sestamibi in follow-up studies because of the development of multidrug resistance, which may block tracer accumulation (1). In our experience, the multidrug-resistant phenotype is characterized by a faster washout of 99mTc-sestamibi rather than a lower early tracer uptake (8,9), and washout rates of 99mTc-sestamibi were indeed predictive of response to chemotherapy in these patients (10). Therefore, when images are acquired 10 min after tracer injection, the diagnostic accuracy of 99mTc-sestamibi scanning is not significantly affected by P-glycoprotein overexpression, and patients with multiple myeloma can confidently be monitored with 99mTc-sestamibi scanning after treatment.

References

  1. Even-Sapir E. Imaging of malignant bone involvement by morphologic, scintigraphic, and hybrid modalities. J Nucl Med. 2005;46:1356–1367.[Abstract/Free Full Text]
  2. Pace L, Catalano L, Pinto AM, et al. Different patterns of technetium-99m sestamibi uptake in multiple myeloma. Eur J Nucl Med. 1998;25:714–720.[Medline]
  3. Catalano L, Pace L, Califano C, et al. Detection of focal myeloma lesions by technetium-99m-sestaMIBI scintigraphy. Haematologica. 1999;84:119–124.[Abstract/Free Full Text]
  4. Pace L, Catalano L, Del Vecchio S, et al. Predictive value of technetium-99m sestamibi in patients with multiple myeloma and potential role in the follow-up. Eur J Nucl Med. 2001;28:304–312.[Medline]
  5. Balleari E, Villa G, Garre S, et al. Technetium-99m-sestamibi scintigraphy in multiple myeloma and related gammopathies: a useful tool for the identification and follow-up of myeloma bone disease. Haematologica. 2001;86:78–84.[Abstract/Free Full Text]
  6. Svaldi M, Tappa C, Gebert U, et al. Technetium-99m-sestamibi scintigraphy: an alternative approach for diagnosis and follow-up of active myeloma lesions after high-dose chemotherapy and autologous stem cell transplantation. Ann Hematol. 2001;80:393–397.[Medline]
  7. Alexandrakis MG, Kyriakou DS, Passam F, Koukouraki S, Karkavitsas N. Value of Tc-99m sestamibi scintigraphy in the detection of bone lesions in multiple myeloma: comparison with Tc-99m-ethylene diphosphonate. Ann Hematol. 2001;80:349–353.[Medline]
  8. Fonti R, Del Vecchio S, Zannetti A, et al. Functional imaging of multidrug resistant phenotype by 99mTc-MIBI scan in patients with multiple myeloma. Cancer Biother Radiopharm. 2004;19:165–170.[Medline]
  9. Pace L, Catalano L, Del Vecchio S, et al. Washout of 99mTc-sestamibi in predicting response to chemotherapy in patients with multiple myeloma. Q J Nucl Med. 2005;49:281–285.




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