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PET/CT studies of multiple myeloma using 18 F-FDG and 18 F-NaF: comparison of distribution patterns and tracers’ pharmacokinetics

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Abstract

Objective

The aim of this prospective study is to evaluate the combined use of fluorine-18 fluorodeoxyglucose (18 F-FDG) and fluorine-18 sodium fluoride (18 F-NaF) PET/CT in the skeletal assessment of patients with multiple myeloma (MM) and to compare the efficacy of these two PET tracers regarding detection of myeloma-indicative osseous lesions.

Patients and methods

The study includes 60 patients with multiple myeloma (MM) diagnosed according to standard criteria. All patients underwent dynamic (dPET/CT) scanning of the pelvis as well as whole body PET/CT studies with both tracers. The interval between the two exams was one day. Sites of focal increased 18 F-FDG uptake were considered as highly suspicious of myelomatous involvement. The lesions detected on the 18 F-NaF PET/CT scans were then correlated with those detected on 18 F-FDG PET/CT, which served as a reference. Moreover, the 18 F-FDG PET/CT results were also correlated with the low-dose CT findings. The evaluation of dPET/CT studies was based on qualitative evaluation, SUV calculation, and quantitative analysis based on a 2-tissue compartment model and a non-compartmental approach.

Results

Whole body 18 F-FDG PET/CT revealed approximately 343 focal lesions while 18 F-NaF PET/CT revealed 135 MM-indicative lesions (39 % correlation). CT demonstrated 150 lesions that correlated with those in 18 F-FDG PET/CT (44 % correlation). Six patients demonstrated a diffuse pattern of disease with 18 F-FDG, while 15 of them had a mixed (diffuse and focal) pattern of skeletal 18 F-FDG uptake. A high number of degenerative, traumatic and arthritic disease lesions were detected with 18 F-NaF PET/CT. In three patients with multiple focal 18 F-FDG-uptake, 18 F-NaF PET/CT failed to demonstrate any bone lesion. The dPET/CT scanning of the pelvic area with 18 F-FDG and 18 F-NaF revealed 77 and 24 MM-indicative lesions, respectively. Kinetic analysis of 18 F-FDG revealed the following mean values: SUVaver = 5.1, k1 = 0.37 (1/min), k3 = 0.10 (1/min), VB = 0.06, influx = 0.04 (1/min), FD = 1.28; the respective values for 18 F-NaF were SUVaverage = 10.7, k1 = 0.25 (1/min), k3 = 0.34 (1/min), VB = 0.02, influx = 0.10 (1/min), FD = 1.37. Apart from the correlation between VB of 18 F-FDG and k1 of 18 F-NaF (r = 0.54), no other significant correlation was observed between the two tracers’ kinetic parameters. We found a significant correlation between FD and SUVaverage (r = 0.93), FD and SUVmax (r = 0.80), FD and influx ( r = 0.85), as well as between influx and SUVaverage (r = 0.74) for 18 F-FDG. In 18 F-NaF we observed the most significant correlations between FD and SUVaverage (r = 0.97), FD and SUVmax (r = 0.87), and between influx and k1 (r = 0.72).

Conclusion

The combined use of 18 F-FDG PET/CT and 18 F-NaF PET/CT provides different molecular information regarding the biological processes that take place in a MM osseous lesion. 18 F-FDG PET/CT proved to be a more specific biomarker than 18 F-NaF PET/CT in multiple myeloma skeletal assessment.

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Acknowledgements

This study is part of the Sonderforschungsbereich-Transregio 79 (SFB-TRR 79) and was financially supported by the Deutsche Forschungsgemeinschaft (German Research Foundation, DFG).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany

    Christos Sachpekidis, Leyun Pan, Caixia Cheng, Uwe Haberkorn & Antonia Dimitrakopoulou-Strauss

  2. Medical Clinic V, University of Heidelberg, Heidelberg, Germany

    Hartmut Goldschmidt & Dirk Hose

  3. National Center for Tumor Diseases Heidelberg, Heidelberg, Germany

    Hartmut Goldschmidt & Dirk Hose

  4. Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany

    Klaus Kopka

  5. Division of Nuclear Medicine, University of Heidelberg, Heidelberg, Germany

    Uwe Haberkorn

  6. Medical PET Group - Biological Imaging Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69210, Heidelberg, Germany

    Christos Sachpekidis

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  1. Christos Sachpekidis
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Correspondence to Christos Sachpekidis.

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Sachpekidis, C., Goldschmidt, H., Hose, D. et al. PET/CT studies of multiple myeloma using 18 F-FDG and 18 F-NaF: comparison of distribution patterns and tracers’ pharmacokinetics. Eur J Nucl Med Mol Imaging 41, 1343–1353 (2014). https://doi.org/10.1007/s00259-014-2721-y

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  • DOI: https://doi.org/10.1007/s00259-014-2721-y

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