From the Istituto di Ematologia e Oncologia Medica "L. e A. Seràgnoli", Università di Bologna, Italia (EZ, PTo, PTa, DC, GP, MC, AB, MB, MC); Istituto di Medicina Nucleare, Policlinico S. ...Orsola-Malpighi, Bologna, Italia (CN, PC, SF);Clinica Ematologica, Dip. di Ricerca Clinica e Morfologica, Università di Udine, Italia (FP, SB, RF); Istituto di Medicina Nucleare, Ospedale S. Maria della Misericordia, Udine, Italia (EE, OG); Istituto di Radiologia, Policlinico S. Orsola-Malpighi, Bologna, Italia (ES)
Correspondence: Michele Cavo, M.D., Istituto di Ematologia ed Oncologia Medica "Seràgnoli", Università degli Studi di Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti, 9 40138 Bologna, Italy. E-mail: mcavo{at}med.unibo.it
Background and Objectives: Bone lesions in multiple myeloma (MM) have been traditionally detected by whole body X-ray (WBXR) survey although magnetic resonance imaging (MRI) has become the gold standard for detecting MM involvement of the spine and pelvis. The aim of this study was to compare a new technique, positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) integrated with computed tomography (18F-FDG PET-CT), with MRI and WBXR for baseline assessment of bone disease in MM.
Design and Methods: We prospectively compared 18F-FDG PET-CT, MRI of the spine-pelvis and WBXR for baseline assessment of bone disease in a series of 46 patients with newly diagnosed MM. In 23 patients who received up front autologous transplantation, we also compared post-treatment PET-CT scans with MR images of the spine and pelvis.
Results: Overall, PET-CT was superior to planar radiographs in 46% of patients, including 19% with negative WBXR. In 30% of patients, PET-CT scans of the spine and pelvis failed to show abnormal findings in areas in which MRI revealed an abnormal pattern of bone marrow involvement, more frequently of diffuse type. In contrast, in 35% of patients PET-CT enabled the detection of myelomatous lesions in areas which were out of the field of view of MRI. By combining MRI of the spine-pelvis and 18F-FDG PET-CT, the ability to detect sites of active MM, both medullary and extramedullary, was as high as 92%. Following transplantation, 15 patients had negative PET-CT scans (including 13 with a very good partial response or at least near complete response), but only 8 had normal MRI.
Interpretation and Conclusions: MRI of the spine and pelvis still remains the gold standard imaging technique for the detection of bone marrow involvement in MM. 18F-FDG PET-CT provides additional and valuable information for the assessment of myeloma bone disease in areas not covered by MRI.
Key words: 18 F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging, whole-body planar radiographs, bone disease, multiple myeloma.
Abstract Objective The aim of this study was to test the relationship between anthropometry, ultrasonography, and dual-energy x-ray absorptiometry (DXA) for the assessment of body composition in ...clinical practice. Methods The study was carried out in Italian blood donor volunteers belonging to five different age groups (18–70 y old; 25 men and 25 women per group; N = 250 participants; n = 125 men, n = 125 women). A complete history was collected and routine blood analyses were performed to confirm healthy status. All participants were submitted to whole-body DXA (tricompartmental analysis, regional, and total body), ultrasonography (abdominal adiposity evaluation), and anthropometric measurements. DXA was used as gold standard and its biomarkers were taken as reference for fat–lean mass balance, central–peripheral fat distribution, central or visceral fat, and subcutaneous fat. Results Anthropometric and ultrasound parameters were closely associated with most of DXA parameters. Composite markers representative of central and abdominal visceral fat compartments were significantly correlated with waist circumference, waist-to-hip ratio, and intra-abdominal fat thickness by ultrasound, in both men and women ( P < 0.025). As expected, subcutaneous depots were significantly correlated with maximum subcutaneous fat thickness measured by ultrasonography ( P < 0.025). Conclusions Both anthropometry and ultrasonography provide a reliable estimate of visceral adipose tissue in a non-obese population compared with DXA, whereas anthropometry prediction of subcutaneous adiposity is weak. Physicians should be aware of the limits of these techniques for the assessment of body composition.
Despite improvements in the methods used in body composition analysis, some goals remain far from clinical practice. Among them, the most important is the quantification of intra-abdominal adipose ...tissue. Fat distribution is a key point in the assessment of cardiovascular and metabolic risk status. The aim of this study was to define the accuracy, reproducibility, and repeatability of ultrasonography in the evaluation of abdominal adiposity.
Twenty-six nonobese patients (group A) who underwent computed tomographic (CT) abdominal imaging and 29 obese patients (group B) were enrolled. Patients from both groups were independently evaluated using ultrasound by three radiologists; computed tomography-like conditions were reproduced, and six main parameters of subcutaneous and internal adiposity were measured (as well as three derived indexes) with both linear and convex probes. In group A, the same measurements were also obtained on CT images. Time spent for every ultrasound session was recorded. Results were analyzed using Lin's concordance correlation (ρ), intraclass correlation, and linear regression analysis (and analysis of variance).
Three patients were excluded from group A after CT scans because of technical problems. Mesenteric fat thickness did not show significant correlations and reliability. Strong correlations between ultrasound and CT measurements were observed for all other visceral and subcutaneous parameters (ρ = 0.85-0.96). Intraobserver and interobserver agreement was excellent in both groups (repeatability: ρ = 0.83-0.99 for group A, ρ = 0.90-0.99 for group B; reproducibility: intraclass correlation coefficient = 0.90-0.99 for groups A and B). The mean time spent was 95 ± 21 seconds for group A (mean body mass index, 27.4 ± 2.4 kg/m(2)) and 129 ± 33 seconds for group B (mean body mass index, 37.3 ± 11.9 kg/m(2)).
Ultrasound is accurate, reproducible, and fast in the analysis of abdominal adiposity. It offers a regional, easy, and close-at-hand evaluation of subcutaneous and visceral fat compartments. This should be taken into consideration when clinical routine examinations are performed or to evaluate patients with specific metabolic diseases before and after treatment.
The objective of this study is to compare the most recent systems for the staging of multiple myeloma (MM), the Durie-Salmon PLUS system and the International Staging System, according to patients' ...survival rates and response to therapy. Another objective is to verify whether patterns of bone marrow alteration on MRI (i.e., focal, diffuse, or variegated patterns) can provide prognostic information for patients with MM.
We retrospectively enrolled 85 patients with MM who were monitored for a minimum of 6 years and who underwent contrast-enhanced spinal and pelvic MRI at 1.5 T and whole-body FDG PET/CT at the time of diagnosis. Patients underwent MM staging performed using both staging systems and were divided into groups on the basis of their MRI patterns. These patient groups were then compared in terms of survival, response to therapy, and duration of response.
Both staging systems showed great capability in differentiating patients with a worse prognosis from patients with a better outcome, with the capability of both systems found to be statistically significant, albeit less statistically significant for the Durie-Salmon PLUS system (p = 0.010 vs p = 0.046, respectively). Patients with a focal pattern on MRI had a worse survival rate than did the patients with other MRI patterns (p = 0.032).
These data indicate that both the International Staging System and the Durie-Salmon PLUS system have great potential for characterizing and stratifying MM to determine the survival outcome and therapy response of patients. Observation of a focal pattern on MRI seems to be associated with poorer survival.
The aim of this study was to investigate the impact of SUVmax fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) measured in the primary tumor, pelvic and para-aortic ...node with disease-free survival (DFS) and overall survival (OS) in patients with locally advanced cervical cancer.
A total of 92 patients with histological diagnosis of locally advanced cervical cancer are treated with radiochemotherapy plus brachytherapy boost from January 2008 to April 2014 in our Institution. A pretreatment FDG-PET/CT for staging and radiotherapy planning was performed, and the value of SUVmax measured in primary tumor and positive nodes was related to DFS and OS.
Univariate analysis showed that DFS is related to FDG-PET/CT positive para-aortic nodes (P = 0.01), International Federation of Gynecology and Obstetrics (FIGO) stage of disease (P = 0.01), and primary tumor SUVmax (P = 0.02), and OS is related to positive para-aortic nodes (P = 0.01) and primary tumor SUVmax (P = 0.02).In multivariate analysis, DFS is modified by FDG-PET/CT positive para-aortic lymph nodes, stage and high T SUVmax (P = 0.02; P = 0.003; P = 0.04), but the only worse prognostic factor of OS is the high SUVmax in the primary tumor (P = 0.01).
We found that T SUVmax, stage, and para-aortic lymph node status assessed by FDG-PET were independent prognostic factors of DFS, whereas only T SUVmax correlated with OS.
Ultrasonography (US) is becoming popular for the assessment of adiposity, but no one has studied this tool in the light of its potential limitations. Our purpose was to investigate the impact of ...technical conditions on the evaluation of abdominal fat by US.
Forty-five healthy males and 45 healthy females were consecutively enrolled in the study, randomly assigned to three groups equally distributed by sex, and examined accordingly to three technical points: fasting state (before and after meal A), breathing (expiration and inspiration B), and US equipment from different generations: 2003 and 1998 (C). Two blinded radiologists performed US in the these opposite conditions, acquiring five parameters representative of subcutaneous and visceral adiposity in two times. Student's t-test and Lin's correlation coefficient were used for statistical analysis to assess differences in the measures as well as in inter- and intra-observer agreements.
The maximum and the only statistically significant changes were observed for intra-abdominal fat thickness regarding fasting state and breathing (Δ% = 24.1 ± 21.3 and Δ% = 9.2 ± 20.4, respectively; P < .0001). Reproducibility and repeatability, especially for visceral fat, were proved more stable in the following conditions: fasting state, expiration, and newer machine (2003).
This article provides essential information and "range of confidence" for variations that can be expected from using different conditions in the measurement of abdominal adiposity by US to be carefully addressed as well as considered by US users and by researchers involving this technique in the field of body composition.
This study evaluated the potential usefulness of (11)C-choline PET/CT for detection and localization of tumors within the prostate. We used the results of step-section histopathologic examination as ...the standard of reference.
The results were analyzed on a sextant basis. We reviewed the results of the (11)C-choline PET/CT scans of 36 patients with prostate cancer and of 5 control subjects with bladder cancer. All patients underwent (11)C-choline PET/CT and, subsequently, radical prostatectomy with lymph node dissection within 1 mo. (11)C-Choline PET/CT scans were obtained 5-10 min after intravenous injection of 370-555 MBq of (11)C-choline. Images were reviewed visually and semiquantitatively using maximum SUV and tumor-to-background ratio.
On a sextant basis, histopathologic analysis detected cancer foci in 143 of 216 sextants; high-grade prostate intraepithelial neoplasm foci were detected in 89 of 216 sextants (in 59 sextants in association with carcinoma, in 30 sextants alone), acute prostatitis was detected in 7 of 216 sextants (in 3 sextants in association with carcinoma, in 4 sextants alone), and 39 of 216 sextants were normal. PET/CT demonstrated focal (11)C-choline uptake in 108 sextants (94 of which involved tumor), and 108 sextants showed no abnormal (11)C-choline uptake (49 of which were false negative). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT were 66%, 81%, 71%, 87%, and 55%, respectively. In the 5 control subjects, high-grade prostate intraepithelial neoplasm was detected at histologic examination in 16 of 30 sextants. PET/CT showed increased (11)C-choline uptake in 5 of 16 sextants.
This study demonstrated the feasibility of using (11)C-choline PET/CT to identify cancer foci within the prostate. However, we also found that (11)C-choline PET/CT has a relative high rate of false-negative results on a sextant basis and that prostatic disorders other than cancer may accumulate (11)C-choline. Therefore, our data do not support the routine use of PET/CT with (11)C-choline as a first-line screening procedure for prostate cancer in men at high risk.
Multiple myeloma (MM) is a malignant B cell and plasma cell disorder which involves the skeleton in more than 80% of patients at diagnosis. The aim of this study was to compare whole-body X-ray ...(WBXR), MRI and (18)F-FDG PET/CT in patients with MM.
The study population comprised 28 newly diagnosed MM patients. Findings of (18)F-FDG PET/CT were compared with those of WBXR and MRI with regard to the number and site of lesions detected.
Comparing (18)F-FDG PET/CT and WBXR, it was found that in 16/28 pts (57%) (18)F-FDG PET/CT detected more lesions, all of which were located in the skeleton. Nine of these 16 patients had a completely negative WBXR survey. In 12/28 pts (43%) the two methods yielded equivalent findings. Comparing (18)F-FDG PET/CT and MRI, it was found that in 7/28 pts (25%), (18)F-FDG PET/CT detected more lytic bone lesions, all of which were located outside the field of view of MRI (bone lesions in six cases and a soft tissue lesion in one). In 14/28 pts (50%), (18)F-FDG PET/CT and MRI detected the same number of lesions in the spine and pelvis, while in 7/28 pts (25%) MRI detected an infiltrative pattern in the spine whereas (18)F-FDG PET/CT was negative.
(18)F-FDG PET/CT appears to be more sensitive than WBXR for the detection of small lytic bone lesions, whereas it has the same sensitivity as MRI in detecting bone disease of the spine and pelvis. On the other hand, MRI may be superior to (18)F-FDG PET/CT in diagnosing an infiltrative pattern in the spine. Therefore, careful evaluation of MM bone disease at diagnosis should include both MRI of the spine and (18)F-FDG PET/CT.
Abstract The aim of this study was to investigate the diagnostic performance of new dual-energy X-ray absorptiometry (DXA) technologies in the detection of vertebral fractures (VFs). Sixty-eight ...patients were submitted to DXA and conventional radiography (XR) on the same day. Lateral images of the spine were independently evaluated by three radiologists with different experience in skeletal imaging, in two sessions with 7 days between evaluations of the same anonymous images. The most expert physician repeated the analysis in a subsequent reading session after further 7 days. Results from expert XR evaluation were considered as gold standard. A semiquantitative approach was used to interpret images and morphometric analysis was performed when a VF was suspected. Seventy vertebrae (70/884, 7.9%) were excluded from the lesion-based analysis, as not evaluable: 11/70 (15.7%) missed by XR only, 56/70 (80.0%) missed by DXA only, 3/70 (4.3%) missed by both techniques (upper thoracic spine). Forty “true” fractures were detected (4.9% out of 814 vertebrae) in 26 patients (38.2% of the 68 studied patients). Twenty-five (62.5%) were mild fractures. DXA sensitivity and specificity were 70.0% and 98.3% on a lesion-based analysis, 73.1% and 90.5% on a patient-based analysis. Intra-observer agreement was excellent with no significant difference between the two techniques. Inter-observer agreement among the 3 observers was higher for XR (k = 0.824 versus 0.720 in the detection of VFs, p = 0.011). DXA accuracy was not influenced by radiologist experience; T4-L4 assessability as well as reproducibility and repeatability of the two techniques and accuracy of DXA were independent from sex, age, body mass index, grade of arthrosis. However DXA sensitivity was affected by mild VFs. Vertebral level did not affect the diagnostic performance with exception of vertebral body assessability. Latest improvements make VFs assessment by DXA competitive with traditional radiographic gold standard, providing consistent advantages and attractions. Few limitations still affect DXA performance and need to be overcome.
PDF
