PT - JOURNAL ARTICLE AU - Mahdi Zirakchian Zadeh AU - Brian Ostergaard AU - Siavash Mehdizadeh Seraj AU - Cyrus Ayubcha AU - William Raynor AU - Oke Gerke AU - Caius Constantinescu AU - Thomas Werner AU - Hongming Zhuang AU - Poul Flemming Hoilund-Carlsen AU - Abass Alavi TI - <strong>Evaluation of myeloma bone disease by means of <sup>18</sup>F-sodium fluoride PET/CT</strong> DP - 2019 May 01 TA - Journal of Nuclear Medicine PG - 24--24 VI - 60 IP - supplement 1 4099 - http://jnm.snmjournals.org/content/60/supplement_1/24.short 4100 - http://jnm.snmjournals.org/content/60/supplement_1/24.full SO - J Nucl Med2019 May 01; 60 AB - 24Objectives: Myeloma bone disease (MBD) is a devastating complication of multiple myeloma (MM). Increased bone destruction and decreased bone formation form the underlying pathological basis of osteolytic lesions in bones of MM patients, which may result in weakened bone and pathological fractures. MBD is associated with higher morbidity and mortality of these patients. 18F-sodium fluoride (NaF) is a sensitive PET tracer that can detect abnormal bone metabolism related to malignancies and, therefore, is particularly suited to evaluate the degree of skeletal involvement in MM patients. This study aimed to determine whether metabolic active volume (MAV) of NaF avid lesions (both lytic and pathologic types) in MM patients could predict survival outcome. Methods: Thirty-seven MM patients (median age 67 years, range: 50-87) from the FULIMA prospective study underwent NaF-PET/CT 90 minutes after administration of the tracer. Using ROVER software (ROVER, ABX, Radeberg, Germany) the active lesions were localized on whole body NaF-PET/CT scans. Spherical masks were placed around active lesions and an adaptive thresholding algorithm automatically calculated the total MAV of each lesion. All lesions in joints that were indistinguishable from osteoarthritis-related NaF uptake were excluded. ROC curves were used to detect the cut-off points for Kaplan-Meier analyses. Univariate and multivariate Cox-regression analyses were used to detect the prognostic values of MAV. Results: A cut off of 38.7 was obtained from ROC curve analysis (AUC: 0.72, sensitivity: 0.67, specificity: 0.78). Higher metabolic volume (&gt; 38.7) was associated with inferior overall survival (OS) in Kaplan-Meier analysis (log rank p: 0.01). In univariate Cox-regression analysis, higher NaF metabolic volume (&gt; 38.7) was associated with inferior OS (HR: 1.03, 95% CI: 1.01-1.06; P= 0.002). In stepwise forward Cox regression analysis, both MAV and Beta-2 microglobulin were significant factors for inferior OS (MAV: HR: 1.06, 95% CI: 1.01-1.11; P= 0.01 and B2: HR: .1.02, 95% CI: 1.00-1.03; P= 0.01). The results for progression-free survival (PFS) were not significant. Conclusions: Higher total MAV in NaF-PET/CT scans of MM patients at baseline was associated with inferior OS. This may imply that NaF-PET/CT could be a valuable imaging modality in assessing the degree of bone involvement and predicting the survival of MM patients.