Multitracer PET/CT with [ 18 F]Fluorodeoxiglucose and [ 18 F]Fluorocholine in the Initial Staging of Multiple Myeloma Patients Applying the IMPeTus Criteria: A Pilot Study.

Initial staging of patients diagnosed with multiple myeloma (MM) can lead to negative results using conventional diagnostic imaging workup, including [ 18 F]Fluorodesoxiglucose ([ 18 F]FDG) PET/CT. The aim of this prospective pilot study was to evaluate the diagnostic efficacy of [ 18 F]Fluorocholine ([ 18 F]FCH) PET/CT in the initial staging of MM patients who were candidates for autologous bone marrow transplant. Materials and Methods : The inclusion criteria of our study were: (a) patients diagnosed with MM; (b) candidates for autologous bone marrow transplant (AT); and (c) studied with [ 18 F]FCH PET/CT and [ 18 F]FDG PET/CT for initial staging less than 4 weeks apart. Imaging analysis included the presence of: bone marrow infiltration, focal bone lesions, and para-medullary or extra-medullary disease, according to the proposed IMPeTus criteria. The analysis was performed per lesion, per patient, and per location. Results : The study population included ten patients. Globally, [ 18 F]FCH PET/CT showed bone marrow uptake in all the patients and visualised 16 more focal lesions than [ 18 F]FDG PET/CT. One patient presented a plasmacytoma, detected by both tracers. Extra-medullary and para-medullary disease was identified with different degrees of uptake by both tracers. In summary, [ 18 F]FCH PET seemed to be superior to [ 18 F]FDG PET/CT in detecting focal bone lesions. SUVmax values were slightly higher in [ 18 F]FCH PET/CT than in [ 18 F]FDG PET/CT. Conclusions : Taking into account the small study population, according to our results, [ 18 F]FCH PET/CT could be a useful tool for staging MM patients.