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18F-FDG PET increases visibility of bone lesions in relapsed multiple myeloma: is this hypoxia-driven?

Esther G M de Waal1, Riemer H J A Slart, Marnix J Leene

  • 1From the Departments of *Hematology, †Nuclear Medicine and Molecular Imaging, and ‡Pathology, University Medical Center Groningen, Groningen, the Netherlands.

Clinical Nuclear Medicine
|December 30, 2014
PubMed
Abstract

Insights

18F-FDG PET detects more skeletal lesions than whole-body x-ray in relapsing multiple myeloma (MM). While FDG uptake relates to HIF-2α signaling, it appears independent of hypoxia in MM patients.

Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiology

Background:

  • Whole-body x-ray (WBX) is standard for detecting skeletal abnormalities in multiple myeloma (MM).
  • 18F-FDG PET offers an alternative by visualizing metabolic changes in malignant cells.
  • Relapsed MM requires sensitive imaging for accurate staging and management.

Purpose of the Study:

  • To compare the lesion detection rate of 18F-FDG PET versus WBX in relapsed MM.
  • To assess the prognostic value of 18F-FDG PET in relapsed MM.
  • To investigate the relationship between 18F-FDG uptake, angiogenesis, and tumor hypoxia.

Main Methods:

  • 44 patients with relapsed MM underwent 18F-FDG PET; 5 underwent 18F-FAZA-PET.
  • 20 patients had bone marrow biopsies analyzed for hypoxia-inducible factors (HIF), vascular endothelial growth factor (VEGF), glucose transporters, and microvessel density.
  • Immunohistochemical staining was performed on biopsy samples.

Main Results:

  • 18F-FDG PET identified significantly more lesions than WBX (P = 0.000001).
  • 18F-FDG PET was not predictive of progression-free or overall survival.
  • Biopsies showed increased microvessel density, VEGF, HIF-2α, and glucose transporter 3 expression, but negative HIF-1α and 18F-FAZA results.

Conclusions:

  • 18F-FDG PET is superior to WBX for diagnosing skeletal lesions in relapsed MM.
  • Enhanced 18F-FDG uptake is linked to HIF-2α pathway activation.
  • The findings suggest FDG uptake in relapsed MM is independent of hypoxia-induced signaling.

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