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Comparison of 11C-Choline and 11C-Methionine PET/CT in Multiple Myeloma

Lapa, Constantin MD*; Kircher, Malte MD*; Da Via, Matteo MD; Schreder, Martin MD; Rasche, Leo MD; Kortüm, K. Martin MD; Einsele, Hermann MD; Buck, Andreas K. MD*; Hänscheid, Heribert PhD*; Samnick, Samuel PhD*

doi: 10.1097/RLU.0000000000002638
Original Articles

Purpose PET/CT with both 11C-choline and 11C-methionine has recently been reported to offer advantages over 18F-FDG for imaging in multiple myeloma (MM). The aim of this study was to directly compare the diagnostic performance of both non-FDG radiotracers in MM patients.

Methods Nineteen patients with a history of MM (n = 18) or solitary bone plasmacytoma (n = 1) underwent both 11C-choline and 11C-methionine PET/CT for diagnostic imaging. In this retrospective analysis, scans were compared on a patient and on a lesion basis. In 12 patients, respective tracer uptake in the iliac crest was correlated with the extent of malignant bone marrow plasma cell infiltration.

Results 11C-methionine detected more intramedullary MM lesions in 8 (42.1%) of 19 patients. In the remainder (11/19 [57.9%]), both 11C-choline and 11C-methionine provided equal results. 11C-methionine demonstrated higher lesion-to-muscle ratios (P = 0.0001). In the 12 patients in whom a recent bone marrow biopsy was available, SUVmean as well as SUVmax correlated significantly with the degree of malignant plasma cell infiltration for both 11C-methionine (SUVmean: r = 0.85, P < 0.001; SUVmax: r = 0.82, P = 0.001) and 11C-choline (SUVmean: r = 0.72, P < 0.008; SUVmax: r = 0.73; P = 0.006).

Conclusions Our data suggest that 11C-methionine PET/CT might be more sensitive than 11C-choline PET/CT for the detection of active MM lesions.

From the Departments of *Nuclear Medicine

Hematology and Oncology, University Hospital Würzburg, Würzburg, Germany.

Received for publication January 23, 2019; revision accepted April 11, 2019.

C.L. and M.K. contributed equally to this work.

Author Contributions: Conception and design: C.L., M.K., L.R., H.H. Development of methodology: C.L., M.D.V., M.S., K.M.K., H.H., S.S. Acquisition of data: C.L., M.K., M.D.V., M.S., L.R., K.M.K. Analysis and interpretation of data: C.L., M.K., M.D.V., M.S., L.R., K.M.K., H.H. Writing, review and/or revision of the manuscript: all authors. Administrative, technical, or material support: HE, A.K.B., H.H., S.S. Supervision: H.E., A.K.B., HH, S.S.

All procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

This work was supported by Wilhelm-Sander-Stiftung (grant 2017.061.1).

Conflicts of interest and sources of funding: none declared.

Correspondence to: Constantin Lapa, MD, Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Strasse 6, D-97080 Würzburg, Germany. E-mail:

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Online date: June 14, 2019

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