11C-Acetate PET/CT for Metabolic Characterization of Multiple Myeloma: A Comparative Study with 18F-FDG PET/CT

Chi-lai Ho; Sirong Chen; Yim Lung Leung; Thomas Cheng; Ka-nin Wong; Shing Kee Cheung; Raymond Liang; Chor Sang Chim

doi:10.2967/jnumed.113.131169

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FIGURE 1.
Algorithm for diagnosis and categorization of symptomatic MM on PET/CT. ACT = acetate; GMA = general marrow activity.
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FIGURE 2.
Dual-tracer PET/CT of patient 14 showing biopsy-confirmed focal bone lesions (arrows) that are purely ¹¹C-acetate–avid. ACT = acetate.
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FIGURE 3.
Strong correlation between serum b2m level and ¹¹C-acetate general marrow activity (A), ¹¹C-acetate focal bone lesion number (B), and ¹⁸F-FDG focal bone lesion number (C). FBL = focal bone lesion.
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FIGURE 4.
(A and B) Patient 18 with focal and diffuse MM avid for ¹¹C-acetate (arrows, A) but not for ¹⁸F-FDG (B). (C and D) Negative findings on posttreatment ¹¹C-acetate (C) and ¹⁸F-FDG (D) PET/CT.

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TABLE 1

Patient Characteristics, Clinical Diagnosis, and Dual-Tracer PET/CT Diagnosis

					General marrow activity		SUV_max (FBLs)		No. of FBLs		PET/CT diagnosis
Patient no.	Sex	Age (y)	M-protein	Clinical diagnosis	¹¹C-ACT	¹⁸F-FDG	¹¹C-ACT	¹⁸F-FDG	¹¹C-ACT	¹⁸F-FDG	¹¹C-ACT	¹⁸F-FDG
1	M	82	IgG κ	III	5.49 (+)	3.60 (+)	15.7	—	28	0	F + D	D
2	M	61	LC κ	III	5.12 (+)	2.23 (−)	—	—	0	0	D	N
3	M	65	LC λ	III	7.88 (+)	1.84 (−)	—	—	0	0	D	N
4	F	57	IgD λ	III	9.90 (+)	6.03 (+)	—	—	0	0	D	D
5	F	76	LC κ	II	4.57 (+)	3.19 (+)	12.2	8.7	50	26	F + D	F + D
6	M	75	IgG κ	II	5.50 (+)	2.70 (−)	—	—	0	0	D	N
7	F	87	IgG κ	II	8.17 (+)	6.70 (+)	11.2	12.5	11	8	F + D	F + D
8	M	62	IgA κ	I	4.10 (+)	2.91 (−)	—	—	0	0	D	N
9	M	62	LC κ	I	7.15 (+)	3.78 (+)	12.6	—	1	0	F + D	D
10	F	69	LC λ	I	4.04 (+)	1.93 (−)	—	—	0	0	D	N
11	M	66	IgA κ	I	8.27 (+)	4.26 (+)	13.3	—	5	0	F + D	D
12	F	69	IgA λ	I	3.94 (+)	2.96 (−)	—	—	0	0	D	N
13	F	52	IgG κ	I	4.43 (+)	5.02 (+)	4.5	6.7	2	4	F + D	F + D
14	M	57	IgA λ	I	4.95 (+)	4.78 (+)	9.5	4.6	8	1	F + D	F + D
15	M	89	IgA κ	I	4.42 (+)	3.03 (+)	18.2	4.9	24	12	F + D	F + D
16	F	56	IgG κ	I	3.83 (+)	5.92 (+)	16.3	21.0	6	6	F + D	F + D
17	F	60	LC λ	I	4.11 (+)	3.15 (+)	20.8	8.9	1	1	F + D	F + D
18	M	63	IgG κ	I	4.95 (+)	2.93 (−)	13.4	7.1	3	2	F + D	F
19	M	57	LC λ	I	3.62 (−)	2.67 (−)	20.5	11.6	11	11	F	F
20	M	64	LC κ	I	5.77 (+)	2.10 (−)	13.4	6.3	4	3	F + D	F
21	F	48	LC κ	I	4.82 (+)	2.53 (−)	—	—	0	0	D	N
22	M	80	IgG λ	I	4.36 (+)	3.67 (+)	—	—	0	0	D	D
23	F	58	IgG κ	I	2.62 (−)	2.24 (−)	—	—	0	0	N	N
24	F	64	IgG κ	I	3.09 (−)	2.91 (−)	—	—	0	0	N	N
25	M	61	IgG λ	I	3.77 (−)	2.20 (−)	—	—	0	0	N	N
26	M	78	IgA κ	I	3.04 (−)	2.98 (−)	—	—	0	0	N	N
27	F	48	IgA λ	I (SMM)	2.78 (−)	2.56 (−)	—	—	0	0	N	N
28	M	72	IgG κ	I (SMM)	3.78 (−)	1.64 (−)	—	—	0	0	N	N
29	M	49	IgG κ	I (SMM)	3.67 (−)	2.71 (−)	—	—	0	0	N	N
30	M	74	IgG λ	I (SMM)	3.11 (−)	2.34 (−)	—	—	0	0	N	N
31	M	51	IgG κ	I (SMM)	2.91 (−)	2.99 (−)	—	—	0	0	N	N
32	M	43	LC κ	MGUS	2.21 (−)	1.79 (−)	—	—	0	0	N	N
33	F	60	IgG λ	MGUS	2.62 (−)	2.44 (−)	—	—	0	0	N	N
34	F	44	IgG κ	MGUS	3.11 (−)	3.29 (+)	—	—	0	0	N	D
35	F	60	IgG λ	MGUS	3.75 (−)	3.62 (+)	—	—	0	0	N	D

M-protein = monoclonal protein; FBL = focal bone lesion; ACT = acetate; F = focal; D = diffuse; LC = light chain; N = negative.

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TABLE 2

Clinical and Dual-Tracer PET/CT Treatment Responses

			% change in focal bone lesion no.
Pattern	Clinical response	% change in ¹¹C-acetate general marrow activity	¹¹C-acetate	¹⁸F-FDG
F + D	Complete remission	−47%	−100%	−100%
F + D	Very good partial response	−41%	−92%	−42%
F + D	Partial response	−29%	−100%	—
F + D	Partial response	−33%	−25%	−33%
F + D	Partial response	−31%	−100%	−100%
F	Partial response	—	−55%	−55%
D	No response	−4%	—	—
D	No response	−8%	—	—
F + D	Progressive disease	37%	33%	100%