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11C-Acetate as a new biomarker for PET/CT in patients with multiple myeloma: initial staging and postinduction response assessment
Authors:Chieh Lin  Chi-Lai Ho  Shu-Hang Ng  Po-Nan Wang  Yenlin Huang  Yu-Chun Lin  Tzung-Chih Tang  Shu-Fan Tsai  Alain Rahmouni  Tzu-Chen Yen
Institution:1. Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, No. 5 Fusing Street, Gueishan, 33305, Taiwan
2. Chang Gung University College of Medicine, Taoyuan, Taiwan
3. Department of Nuclear Medicine and Positron Emission Tomography, Hong Kong Sanatorium and Hospital, Hong Kong, China
4. Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
5. Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
6. Department of Anatomic Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
7. Department of Radiology, AP-HP, Groupe Henri-Mondor Albert-Chenevier, CHU Henri Mondor, Créteil, France
Abstract:

Purpose

We investigated the potential value of 11C-acetate (ACT) PET/CT in characterizing multiple myeloma (MM) compared with 18F-FDG PET/CT. Bone marrow histological and whole-body (WB) MRI findings served as the reference standards.

Methods

In this prospective study, 15 untreated MM patients (10 men and 5 women, age range 48?69 years) underwent dual-tracer 11C-ACT and 18F-FDG PET/CT and WB MRI for pretreatment staging, and 13 of them had repeated examinations after induction therapy. Diffuse and focal bone marrow uptake was assessed by visual and quantitative analyses, including measurement of the maximum standardized uptake value (SUVmax). Between-group differences and correlations were assessed with the Mann-Whitney U test and the Pearson test.

Results

At staging, all 15 patients had diffuse myeloma involvement upon bone marrow examination with 30–90 % of plasma cell infiltrates. Diffuse infiltration was detected in all of them (100 %) using 11C-ACT with a positive correlation between bone marrow uptake values and percentages of plasma cell infiltrates (r = +0.63, p?=?0.01). In contrast, a diagnosis of diffuse infiltration could be established using 18F-FDG in only six patients (40 %). Focal lesions were shown in 13 patients on both 11C-ACT PET/CT and WB MRI, and in 10 patients on 18F-FDG PET/CT. Focal lesions demonstrated 11C-ACT uptake with a mean SUVmax of 11.4 ± 3.3 (range 4.6?19.6, n?=?59), which was significantly higher than the 18F-FDG uptake (mean SUVmax 6.6 ± 3.1, range 2.3?13.7, n?=?29; p?<?0.0001). After treatment, the diffuse bone marrow 11C-ACT uptake showed a mean SUVmax reduction of 66 % in patients with at least a very good partial response versus 34 % in those with at most a partial response only (p?=?0.01).

Conclusion

PET/CT using 11C-ACT as a biomarker showed a higher detection rate for both diffuse and focal myeloma lesions at diagnosis than using 18F-FDG, and may be valuable for response assessment.
Keywords:
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