Bone marrow tracer uptake pattern of PET-CT in multiple myeloma: image interpretation and prognostic value
Jing Li1, Hui Tan2,3, Tianhong Xu1
1Department of Hematology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
Purpose:
To evaluate the prognostic value of bone marrow (BM) imaging pattern and other imaging findings assessed by 18F-FDG PET-CT in multiple myeloma(MM) and to find out the image interpretation cut-off to define different BM tracer uptake pattern.
Materials And Methods:
We retrospectively studied PET-CT examinations and clinical data of 100 healthy individuals and 172 newly diagnosed MM patients. A BM uptake > liver SUVmean was selected as the positivity cut-off of pathological uptake in BM after comparing BM uptake in normal control and MM patients. With this interpretation cut-off, we defined the BM FDG uptake pattern as four types: normal, focal, diffuse, and mixed. The clinical correlation and prognostic value of BM uptake pattern were evaluated. The findings were validated in an independent prospective cohort with 72 MM patients.
Results:
In MM cohort, 34.9% patients had focal BM uptake pattern, 3.5% had diffuse pattern, 38.4% had mixed pattern, and 23.3% had normal BM uptake. Diffuse/mixed pattern was correlated with clinical and imaging parameters indicating high tumor burden, and inferior progression free survival (PFS; 3-year-PFS 26.8%) and overall survival (OS; 3-year-OS 50.6%). BM uptake pattern was an independent prognostic factor and diffuse/mixed pattern was associated with inferior OS (P = 0.037, HR 7.16) and PFS (P = 0.015, HR 7.77). The prognostic value of BM uptake pattern was also confirmed in validation set.
Conclusion:
We propose an FDG uptake higher than liver as the positivity cut-off to discriminate between physiological and pathological uptake in BM and defined four BM FDG uptake pattern. BM FDG uptake pattern is a reliable prognostic predictor of MM.
Insights
18F-FDG PET-CT imaging patterns in bone marrow (BM) can predict outcomes for multiple myeloma (MM) patients. Diffuse or mixed BM uptake indicates higher tumor burden and poorer survival, establishing BM imaging as a reliable prognostic tool for MM.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiology
Background:
- Multiple myeloma (MM) is a hematologic malignancy characterized by uncontrolled plasma cell proliferation.
- Accurate prognostic markers are crucial for tailoring MM treatment strategies.
- 18F-FDG PET-CT offers functional imaging insights into metabolic activity within the bone marrow.
Purpose of the Study:
- To assess the prognostic significance of bone marrow (BM) imaging patterns identified by 18F-FDG PET-CT in multiple myeloma (MM).
- To establish a reliable image interpretation cut-off for defining distinct BM tracer uptake patterns.
- To validate these findings in an independent prospective cohort.
Main Methods:
- Retrospective analysis of 18F-FDG PET-CT scans and clinical data from 100 healthy controls and 172 newly diagnosed MM patients.
- Defined a positivity cut-off for pathological BM uptake as uptake > liver SUVmean.
- Classified BM FDG uptake patterns into normal, focal, diffuse, and mixed, evaluating their clinical correlation and prognostic value.
Main Results:
- In the MM cohort, 23.3% showed normal BM uptake, 34.9% focal, 3.5% diffuse, and 38.4% mixed patterns.
- Diffuse/mixed patterns correlated with high tumor burden and inferior progression-free survival (PFS) and overall survival (OS).
- BM uptake pattern was an independent prognostic factor, with diffuse/mixed patterns linked to significantly poorer OS and PFS (p < 0.05).
Conclusions:
- An 18F-FDG uptake higher than the liver serves as a valid cut-off to distinguish physiological from pathological BM uptake.
- Four distinct BM FDG uptake patterns (normal, focal, diffuse, mixed) can be defined.
- BM FDG uptake patterns are reliable prognostic predictors in patients with multiple myeloma.
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