Prognostic value of visual IMPeTUs criteria and metabolic tumor burden at baseline [¹⁸F]FDG PET/CT in patients with newly diagnosed multiple myeloma.

IF 3.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

EJNMMI Research Pub Date : 2024-05-28 DOI:10.1186/s13550-024-01113-6

Silvano Marchiori, François Cousin, Iraklis Papadopoulos, Claire Bernard, Marie Thys, Bernard De Prijck, Michelle Pirotte, Anne-Françoise Donneau, Roland Hustinx, Jo Caers, Nadia Withofs

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引用次数: 0

Abstract

Background: 2-[¹⁸F]fluoro-2-deoxy-D-glucose ([¹⁸F]FDG) positron emission tomography combined with low-dose computed tomography (PET/CT) can be used at diagnosis to identify myeloma-defining events and also provides prognostic factors. The aim of this study was to assess the prognostic significance of baseline [¹⁸F]FDG PET/CT visual IMPeTUs (Italian myeloma criteria for PET Use)-based parameters and/or total metabolic tumor volume (TMTV) in a single-center population of patients with newly diagnosed multiple myeloma (NDMM) eligible for transplantation.

Methods: Patients with MM who underwent a baseline [¹⁸F]FDG PET/CT were retrospectively selected from a large internal database of the University Hospital of Liege (Liege, Belgium). Initially, all PET/CT images were visually analyzed using IMPeTUs criteria, followed by delineation of TMTV using a semi-automatic lesion delineation workflow, including [¹⁸F]FDG-positive MM focal lesions (FL) with an absolute SUV threshold set at 4.0. In a first step, to ensure PET/CT scans accurate reporting, the agreement between two nuclear medicine physicians with distinct experience was assessed. In the second step, univariable and multivariable analyses were conducted to determine the prognostic significance of [¹⁸F]FDG PET/CT parameters on progression free survival (PFS) and overall survival (OS), respectively.

Results: A total of 40 patients with NDMM were included in the study. The observers agreement in the analysis [18F]FDG PET/CT images was substantial for the presence of spine FL, extra spine FL, at least one fracture and paramedullary disease (Cohen's kappa 0.79, 0.87, 0.75 and 0.64, respectively). For the presence of skull FL and extramedullary disease the agreement was moderate (Cohen's kappa 0.56 and 0.53, respectively). Among [¹⁸F]FDG PET/CT parameters, a high number of delineated volumes of interest (VOI) using the SUV4.0 threshold was the only independent prognostic factor associated with PFS [HR (95% CI): 1.03 (1.004-1.05), P = 0.019] while a high number of FL (n > 10; F group 4) was the only independent prognostic factor associated with OS [HR (95% CI): 19.10 (1.90-191.95), P = 0.01].

Conclusion: Our work confirms the reproducibility IMPeTUs criteria. Furthermore, it demonstrates that a high number of FL (n > 10; IMPeTUs F group 4), reflecting a high [¹⁸F]FDG-avid tumor burden, is an independent prognostic factor for OS. The prognostic value of the TMTV delineated using a SUV4.0 threshold was not significant. Nevertheless, the count of delineated [¹⁸F]FDG-avid lesions VOI using a SUV4.0 threshold was an independent prognostic factor for PFS.

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新诊断多发性骨髓瘤患者的视觉 IMPeTUs 标准和基线 [18F]FDG PET/CT 代谢肿瘤负荷的预后价值。

背景：2-[18F]氟-2-脱氧-D-葡萄糖（[18F]FDG）正电子发射断层扫描联合低剂量计算机断层扫描（PET/CT）可在诊断时用于识别骨髓瘤决定性事件，并提供预后因素。本研究旨在评估基线[18F]FDG PET/CT视觉IMPeTUs（意大利骨髓瘤PET使用标准）为基础的参数和/或总代谢肿瘤体积（TMTV）在单中心符合移植条件的新诊断多发性骨髓瘤（NDMM）患者群体中的预后意义：方法：从列日大学医院（比利时列日）的大型内部数据库中回顾性地筛选出接受了基线[18F]FDG PET/CT检查的多发性骨髓瘤患者。首先，使用 IMPeTUs 标准对所有 PET/CT 图像进行视觉分析，然后使用半自动病灶划分工作流程划分 TMTV，包括[18F]FDG 阳性 MM 局灶病灶（FL），绝对 SUV 阈值设定为 4.0。第一步，为确保 PET/CT 扫描报告的准确性，评估了两位具有不同经验的核医学医生之间的一致性。第二步，进行单变量和多变量分析，分别确定[18F]FDG PET/CT参数对无进展生存期（PFS）和总生存期（OS）的预后意义：研究共纳入40例NDMM患者。观察者在分析[18F]FDG PET/CT图像时，对于是否存在脊柱FL、脊柱外FL、至少一处骨折和髓旁疾病，意见基本一致（Cohen's kappa分别为0.79、0.87、0.75和0.64）。颅骨FL和髓外疾病的一致性为中等（Cohen's kappa分别为0.56和0.53）。在[18F]FDG PET/CT参数中，使用SUV4.0阈值划定的感兴趣容积（VOI）数量多是唯一与PFS相关的独立预后因素[HR（95% CI）：1.03（1.004-1.05），P = 0.019]，而FL数量多（n > 10；F组4）是唯一与OS相关的独立预后因素[HR（95% CI）：19.10（1.90-191.95），P = 0.01]：我们的研究证实了 IMPeTUs 标准的可重复性。结论：我们的研究证实了 IMPeTUs 标准的可重复性，此外，它还证明了 FL 数量多（n > 10；IMPeTUs F 组 4），反映了高[18F]FDG-avid 肿瘤负荷，是 OS 的独立预后因素。使用 SUV4.0 阈值划定的 TMTV 的预后价值并不显著。然而，使用 SUV4.0 阈值划定的[18F]FDG-avid 病灶 VOI 计数是 PFS 的独立预后因素。

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来源期刊

EJNMMI Research RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING&nb-

CiteScore

5.90

自引率

3.10%

发文量

审稿时长

13 weeks

期刊介绍： EJNMMI Research publishes new basic, translational and clinical research in the field of nuclear medicine and molecular imaging. Regular features include original research articles, rapid communication of preliminary data on innovative research, interesting case reports, editorials, and letters to the editor. Educational articles on basic sciences, fundamental aspects and controversy related to pre-clinical and clinical research or ethical aspects of research are also welcome. Timely reviews provide updates on current applications, issues in imaging research and translational aspects of nuclear medicine and molecular imaging technologies. The main emphasis is placed on the development of targeted imaging with radiopharmaceuticals within the broader context of molecular probes to enhance understanding and characterisation of the complex biological processes underlying disease and to develop, test and guide new treatment modalities, including radionuclide therapy.