Contributions
Abstract: PB1995
Type: Publication Only
Background
Multiple myeloma (MM) is characterized by plasma cell proliferation and expansion primarily in the bone marrow. Modern assessment of MM using FDG-PET has so far mostly been limited to the analysis of focal lesions, requiring subjective interpretation to determine overall disease activity.
Aims
A novel method using CT segmentation to determine global bone marrow activity portrayed by FDG uptake was used to achieve a comprehensive understanding of disease burden in patients with MM before and after therapy.
Methods
Prospective FDG-PET/CT data of 23 MM patients between ages of 50 and 76 (mean = 64.3, males = 21, females = 2) were collected from Odense University Hospital (NCT02187731) and included scans before initiation of treatment and at end of treatment (EOT) two months after high dose chemotherapy with stem cell support. . All scans were conducted 60 min after intravenous injection of 4 MBq/kg of FDG. Images were analyzed using an iterative thresholding algorithm that delineates a continuous region based on Hounsfield units from the CT data (OsiriX software; Pixmeo SARL; Bernex, Switzerland), allowing for segmentation of the total skeleton on a fused PET/CT image. This enabled the quantification of FDG uptake representing the entire skeleton, providing a global SUVmean that considers all bone marrow involvement. Global SUVmean scores were compared before and at EOT using a two-tailed paired t test.
Results
A decrease in marrow FDG uptake was observed at EOT compared to baseline in most patients. The calculated global SUVmean uptake decreased after initiation of treatment in 17 (73.9%) of the cases and increased in 6 (26.1%) of the cases, supported by the observed statistical difference of the dependent means before and after treatment (P = 0.0053).
Conclusion
We assessed the effects of treatment in MM patients using a novel technique for global quantification of FDG uptake in the bone marrow and skeleton and found lower global uptake at EOT. However, a limitation of bone segmentation is present in cases with extramedullary disease. Global assessment rather than focal analysis of discrete lesions represents a robust and straightforward method of determining total disease activity that potentially will be of value in treatment evaluation, disease monitoring and prognostication in multiple myeloma.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Remission, Multiple Myeloma, FDG-PET
Abstract: PB1995
Type: Publication Only
Background
Multiple myeloma (MM) is characterized by plasma cell proliferation and expansion primarily in the bone marrow. Modern assessment of MM using FDG-PET has so far mostly been limited to the analysis of focal lesions, requiring subjective interpretation to determine overall disease activity.
Aims
A novel method using CT segmentation to determine global bone marrow activity portrayed by FDG uptake was used to achieve a comprehensive understanding of disease burden in patients with MM before and after therapy.
Methods
Prospective FDG-PET/CT data of 23 MM patients between ages of 50 and 76 (mean = 64.3, males = 21, females = 2) were collected from Odense University Hospital (NCT02187731) and included scans before initiation of treatment and at end of treatment (EOT) two months after high dose chemotherapy with stem cell support. . All scans were conducted 60 min after intravenous injection of 4 MBq/kg of FDG. Images were analyzed using an iterative thresholding algorithm that delineates a continuous region based on Hounsfield units from the CT data (OsiriX software; Pixmeo SARL; Bernex, Switzerland), allowing for segmentation of the total skeleton on a fused PET/CT image. This enabled the quantification of FDG uptake representing the entire skeleton, providing a global SUVmean that considers all bone marrow involvement. Global SUVmean scores were compared before and at EOT using a two-tailed paired t test.
Results
A decrease in marrow FDG uptake was observed at EOT compared to baseline in most patients. The calculated global SUVmean uptake decreased after initiation of treatment in 17 (73.9%) of the cases and increased in 6 (26.1%) of the cases, supported by the observed statistical difference of the dependent means before and after treatment (P = 0.0053).
Conclusion
We assessed the effects of treatment in MM patients using a novel technique for global quantification of FDG uptake in the bone marrow and skeleton and found lower global uptake at EOT. However, a limitation of bone segmentation is present in cases with extramedullary disease. Global assessment rather than focal analysis of discrete lesions represents a robust and straightforward method of determining total disease activity that potentially will be of value in treatment evaluation, disease monitoring and prognostication in multiple myeloma.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Remission, Multiple Myeloma, FDG-PET