Thoracic aorta atherosclerosis in multiple myeloma patients assessed by18F sodium fluoride PET/CT

Objectives: This study aimed to assess the amount of 18F-sodium fluoride (NaF) uptake in the thoracic aorta as an early indication of atherosclerosis in multiple myeloma (MM) patients compared to healthy control (HC) subjects. We hypothesized that MM patients would present with higher values of FDG uptake.

Methods: Retrospectively, 44 untreated MM patients including 9 with smoldering MM (mean age 63.8 years, range 50-75, 30 males) were selected from the FULIMA study conducted at the Departments of Hematology in the cities of Odense and Vejle in the Region of Southern Denmark. Twenty-six age-matched healthy control (HC) subjects (mean age 61.03 years, range 53-75, 12 males) were selected from the CAMONA study, approved by the Danish National Committee on Health Research Ethics. Each individual’s NaF-PET uptake in the ascending aorta (AA), aortic arch (AR)and descending aorta (DA)was determined by means of OSIRIX Software (Pixmeo SARL, Bernex, Switzerland). Average global SUVmean (AGSmean) was obtained for each aortic part as the sum of the products of the segmented aortic area in each slice multiplied by its related standardized uptake value (SUV mean) divided by the sum of all segmented slice areas. For normalization, the target to background ratio (TBR) was calculated using superior vena cava counts as the background value.

Results: Significant differences between the MM group and the HC group were observed with regard to both AGSmean: AA (MM=1.05±0.21, HC=0.90±0.20, p<0.001), AR (MM=1.12±0.23, HC=0.93±0.69, p<0.001) DA (MM=1.21±0.26, HC=1.00±0.21, p<0.001) and TBR: AA (MM=1.82±0.21, HC=1.24±0.02, p<0.001), AR (MM=1.71±0.19, HC=1.28±0.03, p<0.001), DA (MM=1.96±0.28, HC=1.38±0.03, p<0.001). There were no significant uptake differences between men and women.

Conclusions: A higher uptake of NaF was observed in the thoracic aorta of MM patients in comparison to the healthy control subjects suggesting an MM-associated increased tendency of atherosclerosis development.