Abstract
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Introduction: uEXPLORER as the first 2-meter long total-body PET scanner, has brought tracer kinetics analysis into a new era. [11C] methionine (11C-MET) has advantages over 18F-FDG for PET imaging in multiple myeloma (MM). There is not any report on 11C-MET dynamic PET imaging of multiple myeloma so far. The aim of the study is to establish a kinetic model suitable for total-body dynamic 11C-MET PET/CT, and to evaluate its clinical application value in multiple myeloma.
Methods: Dynamic total-body 11C-MET PET/CT was conducted with uEXPLORER in 9 subjects (7 MM patients and 2 controls, aged 69±6.1 years). All of the patients had been given informed consent under the guidance of the Institutional Review Board of Ren Ji Hospital (Shanghai, China). 11C-MET (788 ±102 MBq) were injected intravenously in the foot, then dynamic total-body scan was performed for one hour. The datasets were divided into 92 frames: 30*2sec, 12*5sec, 6*10sec, 4*30sec, 25*60sec and 15*120sec. The time activity curves (TACs) of organs and bone marrows were extracted. Model fitting of TACs was operated using PMOD Kinetic Modeling through a reversible two-tissue compartment model (rev2TCM), an irreversible two-tissue compartment model, a patlak plot and a logan plot respectively. The four models were optimized by (1) visual inspection and (2) goodness-of-fit displayed by the Akaike information criterion (AIC) and Schwartz information criterion (SC). R software was used to analyze the correlation between dynamic parameters and clinical indicators.
Results: The uptake of 11C-MET increased gradually in liver, pancreas and muscle; whereas the kidney, spleen and lung had an early peak in 11C-MET uptake followed by a gradual decline in concentration. The rev2TCM has a best fitting with TACs among the four models (AIC= -12.238, SC=0.371, R2= 0.994 for bone marrow). MM patients had higher 11C-MET uptakes in bone marrow compared with controls (SUVmax : 14.5±6.6 vs 6.2±0.8 g/mL, p=0.014). The dynamic parameters (Flux: r=0.848, p=0.016; Vs: r=0.788, p=0.035 and Vt: r=0.793, p=0.034) rather than SUVmax (r=0.703, p=0.078), were found to be correlated with M protein levels in MM patients.
Conclusions: This study demonstrated the capability of dynamic total-body 11C-MET PET/CT in visualizing of MM. The dynamic parameters achieved by the rev2TCM has an advantage in evaluating the progression of MM patients.
Acknowledgements: The study was sponsored by the National Natural Science Foundation of China (Grant Nos.82102089).
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