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Query: UMLS:C0026764 (multiple myeloma)
 36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Experience of scintigraphic detection of bone lesion and active bone marrow involvement of multiple myeloma, especially with sestamibi and FDG-PET scans is in evolution. We report a case of intense sestamibi uptake in bone marrow correlating with the extent of the disease, while FDG-PET scans showed activity only in areas of active disease progression associated with pain. Technetium-99m-sestamibi appears to indicate the extent of the disease, while [18F]FDG-PET scans show sites of active tumor proliferation and may be useful in directing local therapy such as radiation.
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PMID:Technetium-99m-MIBI versus fluorine-18-FDG in diffuse multiple myeloma. 925 51

Positron emission tomography with 2-deoxy-2-[18]fluoro-D-glucose (FDG-PET) imaging has been extensively used to detect occult metastatic malignant lesions in patients with carcinoma. We describe its use in three patients with multiple myeloma, each representing a particular clinical situation in which this imaging modality offered advantages over plain radiography, computerized tomography or magnetic resonance imaging. FDG-PET provides a whole body image showing sites of occult disease. This is of particular value in patients with non-secretory myeloma, solitary plasmacytoma or for those that relapse with focal disease following autologous or allogeneic stem cell transplantation.
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PMID:Fluoro-deoxyglucose positron emission tomography imaging for the detection of occult disease in multiple myeloma. 1191 44

This prospective study was undertaken to investigate the appearance of multiple myeloma on fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). Furthermore, the accuracy of FDG-PET in detecting myeloma lesions and its influence on patient management were evaluated. Forty-three patients with known multiple myeloma (n=28) or solitary plasmacytoma (n=15) underwent FDG-PET. The results of routinely performed radiographs and of scans obtained using all available imaging modalities (MRI, CT), as well as the clinical course, were used for verification of detected lesions. Focally increased tracer uptake was observed in 38 of 41 known osteolytic bone lesions (sensitivity 92.7%) in 23 patients. In addition, 71 further bone lesions which were negative on radiographs were detected in 14 patients. Twenty-six (36.6%) of these lesions could be confirmed in ten patients. As a result of FDG-PET imaging, clinical management was influenced in five (14.0%) patients. The positive predictive value for active disease was 100% in patients with focal or mixed focal/diffuse skeletal FDG uptake and 75% in patients with diffuse bone marrow uptake. Depending on the interpretation of the PET scans in patients with diffuse bone marrow uptake, the sensitivity ranged from 83.8% to 91.9% and the specificity from 83.3% to 100%. FDG-PET thus proved highly accurate in detecting multiple myeloma, and revealed a greater extent of disease than routine radiographs in 14 of 23 (60.9%) patients who had osteolytic bone lesions. FDG-PET might contribute to the initial staging of solitary plasmacytoma.
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PMID:Initial results in the assessment of multiple myeloma using 18F-FDG PET. 1200 11

The use of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in the evaluation and management of patients with malignancy continues to increase. However, its role in the identification of bone metastases is far from clear. FDG has the advantage of demonstrating all metastatic sites, and in the skeleton it is assumed that its uptake is directly into tumor cells. It is probable that for breast and lung carcinoma, FDG-PET has similar sensitivity, although poorer specificity, when compared with the isotope bone scan, although there is conflicting evidence, with several articles suggesting that it is less sensitive than conventional imaging in breast cancer. There is convincing evidence that for prostate cancer, FDG-PET is less sensitive than the bone scan and this may be tumor specific. There is very little data relating to lymphoma, but FDG-PET seems to perform better than the bone scan. There is an increasing body of evidence relating to the valuable role of FDG-PET in myeloma, where it is clearly better than the bone scan, presumably because FDG is identifying marrow-based disease at an early stage. There are, however, several other important variables that should be considered. The morphology of the metastasis itself appears to be relevant. At least in breast cancer, different patterns of FDG uptake have been shown in sclerotic, lytic, or lesions with a mixed pattern, Furthermore, the precise localization of a metastasis in the skeleton may be important with regard to the extent of the metabolic response induced. Previous treatment is highly relevant and it has been found that although the majority of untreated bone metastases are positive on PET scans and have a lytic pattern on computed tomography (CT), after treatment, incongruent CT-positive/PET-negative lesions are significantly more prevalent and generally are blastic, which presumably reflects a direct effect of treatment. Finally, the aggressiveness of the tumor itself may be relevant. The most important question, however, is irrespective of whether a lesion is seen on x-ray, CT, or bone scan and irrespective of lytic of blastic morphology: if the FDG-PET study is negative, what is the clinical relevance of that lesion?
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PMID:Positron emission tomography and bone metastases. 1576 76

A 55-y-old patient with multiple myeloma presented for restaging after chemotherapy and radiation. The patient had undergone vertebroplasty of multiple thoracic vertebrae because of painful compression fractures. The 18F-FDG PET images showed increased activity at the T8 and T10-T12 vertebral bodies. Comparison of the attenuation-corrected and non-attenuation-corrected images demonstrated that the activity was due to an artifact of attenuation correction. The CT scan correlated the sites of vertebroplasty to the 4 foci of increased uptake of 18F-FDG. The increasing use of vertebroplasty for malignant spinal fractures warrants vigilance for this artifact.
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PMID:Artifactual spinal metastases imaged by PET/CT: a case report. 1632 23

Radiologists play a central role in the diagnosis, initial staging, follow-up, and restaging of patients with myeloma. This review article attempts to familiarize the reader with all the various types of myeloma, their imaging appearances and useful imaging strategies. The staging system for myeloma patients has been updated and now includes findings from advanced imaging modalities. Radiologists have a vast array of imaging modalities at their disposal to aid them in diagnosis, staging, and follow-up. Currently, conventional radiographic skeletal surveys, magnetic resonance imaging, and F-18 FDG PET/CT examinations are the most useful instruments.
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PMID:Imaging techniques used in the diagnosis, staging, and follow-up of patients with myeloma. 1637 91

Staging is the cornerstone of baseline myeloma evaluation. New imaging techniques such as magnetic resonance imaging (MRI), whole body FDG-PET scanning and whole body CT (combined with PET directly or by fusion) offer the opportunity to precisely stage patients by anatomic and functional techniques. The new Durie/Salmon PLUS staging system integrates these new imaging techniques into a new generation of anatomic and functional myeloma staging. It is possible to discriminate between the impact of tumour burden (myeloma cell mass) and other prognostic factors. This refined classification by stage and prognostic category is increasingly important in clinical trials. The value of clinical staging in patient management is emphasized both in discrimination of early disease status and clearer identification of poorer risk of Stage II and III disease. Wider use of newer imaging will undoubtedly enhance analysis of new trials incorporating novel agents.
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PMID:The role of anatomic and functional staging in myeloma: description of Durie/Salmon plus staging system. 1677 5

Osteonecrosis of the maxillary or mandibular bone is an infrequent but often severe event occurring in patients who undergo prolonged treatment with bisphosphonates. Histology is in some cases mandatory to differentiate it from neoplastic osteolysis, but a biopsy can further contribute to bone damage. Functional imaging obtained by a tracer that shows oncotropic properties, such as Tc99m-sestamibi, in comparison to a non-tumor-specific substance such as FDG-PET, can support the differential diagnosis, thus avoiding invasive procedures. Four patients affected by multiple myeloma and jaw osteonecrosis were prospectively evaluated by sestamibi and FDG-PET scans. Local diagnosis was performed by clinical, radiological and, in some cases, histological evaluations. Each patient was studied by Tc99m-sestamibi, performed by planar anterior and posterior whole-body scans and SPECT of the head and neck, and by PET/CT. Two nuclear medicine physicians, unaware of the final diagnosis, reviewed the images. No sestamibi uptake was evident in the four patients with jaw osteonecrosis, while FDG-PET/CT showed focal uptake in all of them. Our study suggests that the combined use of sestamibi scintigraphy and FDG-PET/CT could support the clinical diagnosis of oral osteonecrosis avoiding the risks of a surgical biopsy. Studies on higher number of patients are necessary to validate these preliminary observations.
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PMID:Sestamibi and FDG-PET scans to support diagnosis of jaw osteonecrosis. 1728 74

Multiple myeloma is the most common plasma cell neoplasm, with abnormal clonal proliferation of B cells in bone marrow. Its staging is important for therapeutic management and prognosis. F-18 FDG PET/CT is of proven value in staging and posttherapeutic monitoring multiple myeloma. Through imaging integration, PET provides functional detection of high metabolic lesions whereas CT provides correlated anatomic localization. The authors present a case of multiple myeloma status post chemotherapy and stem cell transplant with diffuse osseous and extramedullary lesions evaluated by PET/CT. The extramedullary involvement concerns the maxillary sinus, thyroid cartilage, mediastinum, retroperitoneum, neuroforamen, and epidura.
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PMID:F-18 FDG PET/CT staging of multiple myeloma with diffuse osseous and extramedullary lesions. 1788 62

The aim of our study was to evaluate the role of fluorine-18 fluorodeoxyglucose positron emission tomography (FDGPET) in 49 patients with plasma cell malignancies. FDG-PET results were verified by conventional imaging methods, including plain radiographs, magnetic resonance imaging (MRI) and computer tomography (CT). Focally increased FDG uptake was observed in three (23 %) of 11 newly diagnosed myeloma patients with negative bone radiographs. Focally increased tracer uptake was found in five of 26 patients with MM in remission but with suspected relapse. Of the 20 patients who had negative FDG-PET scans, only one relapsed 12 months after FDG-PET examination.. FDG-PET was positive in two of six patients with MGUS and with suspected progression to MM or with suspected other malignancy. In one case a thyroid carcinoma was later detected, in the other an intestinal tumor was found. We conclude that FDG PET might contribute to initial staging of MM patients with negative bone radiographs and is useful for the follow-up of patients in remission especially in non-secretory MM and in patients with large plasmocytoma (>5 cm) after radiochemotherapy.
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PMID:Fluorodeoxyglucose positron emission tomography in multiple myeloma, solitary plasmocytoma and monoclonal gammapathy of unknown significance. 1794 38


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