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Theranostics 2016; 6(2):254-261. doi:10.7150/thno.13921 This issue Cite

Research Paper

¹¹C-Methionine-PET in Multiple Myeloma: Correlation with Clinical Parameters and Bone Marrow Involvement

Constantin Lapa^1,4✉, Stefan Knop^2,4, Martin Schreder^2,4, Martina Rudelius^3,4, Markus Knott^2,4, Gerhard Jörg^1,4, Samuel Samnick^1,4, Ken Herrmann^1,4, Andreas K. Buck^1,4, Hermann Einsele^2,4, Katharina Lückerath^1,4

1. University Hospital Würzburg, Department of Nuclear Medicine, Würzburg, Germany
2. University Hospital Würzburg, Department of Hematology and Oncology, Würzburg, Germany
3. Institute for Pathology, University of Würzburg, Würzburg, Germany
4. Comprehensive Cancer Center Mainfranken, Würzburg, Germany

✉ Corresponding author: Constantin Lapa, MD, University Hospital Würzburg, Department of Nuclear Medicine, Oberdürrbacher Strasse 6, D-97080 Würzburg. E-mail: lapa_cde, phone: +49-931-201-35412, fax: +49-931-201-635000

Abstract

Multiple myeloma (MM) remains an essentially incurable hematologic malignancy originating from clonal plasma cells. This study evaluated the usefulness of the radiotracers ¹¹C-methionine (MET) and ¹⁸F-2`-deoxy-2`-fluorodeoxyglucose (FDG) for staging and re-staging in MM.

43 patients with MM underwent both MET- and FDG-PET/CT for staging or re-staging within 3±2 days. Scans were compared on a patient and on a lesion basis. Tracer uptake was correlated with the degree of bone marrow (BM) involvement and standard clinical parameters of disease activity. Additionally, BM samples were stained for L-type amino acid transporter 1 (LAT1) expression in 15 patients. MET-PET detected focal lesions (FL) in 39/43 subjects (90.7%), whereas 10 patients were missed in FDG-PET/CT (detection rate, 33/43; 76.7%; p<0.05). MET depicted more FL in 28/43 patients (65.1%; p<0.001), whereas in the remainder (34.9%, n=15) both tracers yielded comparable results. LAT1 was highly expressed on the cell surface of myeloma cells. Both FDG and MET uptake correlated significantly with biopsy-proven BM involvement (p<0.001), with MET demonstrating a stronger correlation (SUV_mean, r=0.9 vs r=0.6; SUV_max, r=0.88 vs r=0.58). Abnormal beta-2-microglobulin and free light chain levels correlated with the presence of focal intramedullary lesions detected in MET- or FDG-PET/CT (MET, p=0.006 and p=0.01, respectively; FDG, p=0.02 and p=0.01). MET appears to be superior to FDG for staging and re-staging of both intra- and extramedullary MM lesions. Tracer uptake correlates with BM involvement, β2m and FLC levels and appears to be a more accurate marker of tumor burden and disease activity.

Keywords: PET/CT, ¹¹C-methionine, multiple myeloma, FDG

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