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Value of FDG PET in the Assessment of Patients with Multiple Myeloma

Miriam A. Bredella1,2, Lynne Steinbach1, Gary Caputo2, George Segall3 and Randall Hawkins2

1 Department of Radiology, Massachusetts General Hospital, 15 Parkman St., WACC 515, Boston, MA 02114.
2 Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628.
3 Department of Nuclear Medicine, VA Palo Alto Health Care System, Palo Alto, CA 94304.



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  		Fig. 1. —55-year-old woman with newly diagnosed multiple myeloma, evaluated pretherapy. Whole-body FDG PET shows multiple foci of increased FDG uptake in bone marrow throughout the body, consistent with myelomatous involvement. Standardized uptake values of lesions ranged from 3.8 to 6.2.

 


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  		Fig. 2A. —56-year-old woman with multiple myeloma, pretherapy. Coronal FDG PET shows no abnormal FDG uptake and was interpreted as normal.

 


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  		Fig. 2B. —56-year-old woman with multiple myeloma, pretherapy. Sagittal FDG PET through left upper extremity shows only mildly increased FDG uptake in left humerus (arrow) that was not detected prospectively.

 


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  		Fig. 2C. —56-year-old woman with multiple myeloma, pretherapy. Radiograph of left humerus shows large lytic lesion (arrow), corresponding to area of abnormal FDG uptake. This was found to represent myelomatous involvement on subsequent biopsy.

 


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  		Fig. 3A. —43-year-old man with high-grade plasmacytoma of right hemipelvis, status postchemotherapy and bone marrow transplant. Coronal fat-suppressed T1-weighted MRI with gadopentetate dimeglumine shows abnormal enhancing soft tissue in right hemipelvis.

 


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  		Fig. 3B. —43-year-old man with high-grade plasmacytoma of right hemipelvis, status postchemotherapy and bone marrow transplant. Coronal FDG PET shows abnormal FDG uptake in right hemipelvis with standardized uptake value ranging from 4.3 to 5.0.

 


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  		Fig. 4A. —41-year-old patient with multiple myeloma of C1/C2, status post posterior spinal fusion, chemotherapy, and bone marrow transplant 9 months ago. Sagittal fat-suppressed T1-weighted MRI with gadopentetate dimeglumine shows abnormal enhancing soft tissue (arrow) at C1/C2, suspicious for recurrent myeloma.

 


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  		Fig. 4B. —41-year-old patient with multiple myeloma of C1/C2, status post posterior spinal fusion, chemotherapy, and bone marrow transplant 9 months ago. Sagittal FDG PET shows no abnormal FDG uptake in cervical spine. Patient was followed clinically and there was no evidence of recurrent tumor over 1 year. Note physiologic FDG uptake in the oropharynx (arrow).

 


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  		Fig. 4C. —41-year-old patient with multiple myeloma of C1/C2, status post posterior spinal fusion, chemotherapy, and bone marrow transplant 9 months ago. Axial CT image through upper cervical spine obtained for neck pain 8 months later shows lytic lesions at C1/C2 at site of original tumor (arrow). These findings were thought to represent recurrent tumor. Note posterior spinal fusion hardware.

 


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  		Fig. 4D. —41-year-old patient with multiple myeloma of C1/C2, status post posterior spinal fusion, chemotherapy, and bone marrow transplant 9 months ago. Sagittal FDG PET shows no abnormal FDG uptake and patient improved clinically without evidence of recurrent tumor.

 


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  		Fig. 4E. —41-year-old patient with multiple myeloma of C1/C2, status post posterior spinal fusion, chemotherapy, and bone marrow transplant 9 months ago. Sagittal fat-suppressed T1-weighted MRI with gadopentetate dimeglumine, obtained 7 months later for alteration in blood parameters that was suspicious for recurrent tumor. There is abnormal enhancing soft tissue at C1/C2 (arrow) that was thought to represent recurrent tumor.

 


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  		Fig. 4F. —41-year-old patient with multiple myeloma of C1/C2, status post posterior spinal fusion, chemotherapy, and bone marrow transplant 9 months ago. Sagittal FDG PET obtained same day shows no abnormal FDG uptake in cervical spine; however, new focus of intense FDG uptake (standardized uptake value: 4.3) is noted in left sacroiliac region (arrow) that was found to represent myeloma on subsequent biopsy.

 

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