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Clinical Utility of 18F-Florbetaben PET for Detecting Amyloidosis Associated With Multiple Myeloma

A Prospective Case-Control Study

Seo, Minjung MD, PhD*; Cha, Hee Jeong MD, PhD; Kim, Misung MD; Park, Sang Hyuk MD, PhD; Lim, Ji Hun MD, PhD; Choi, Yunsuk MD, PhD§; Lee, Yoo Jin MD, PhD§; Park, Seol Hoon MD*; Jo, Jae-Cheol MD, PhD§

doi: 10.1097/RLU.0000000000002699
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Purpose The aims of this study were to evaluate the diagnostic performance of 18F-florbetaben PET/CT for detecting amyloid deposits in patients with multiple myeloma (MM) and to identify the optimal PET analysis method.

Methods Fourteen patients with MM were prospectively enrolled (6 with amyloidosis, 8 control subjects). Dynamic imaging of the kidneys was performed for 20 minutes, and the retention ratio was obtained. At 90 minutes after injection, PET was performed. All images were assessed qualitatively and quantitatively, and the SUVmax, SUVmean, and SUVratio were obtained. Variables were compared between the amyloidosis group and the control group. Amyloid deposition was confirmed according to international consensus guidelines.

Results Tracer uptake was abnormal in all patients with amyloidosis. The visual detection rate was excellent (100%) in the heart, stomach, and tongue but limited in the kidneys (50%) and poor (0%) in the esophagus, liver, and colon. 18F-florbetaben PET/CT identified 13 unexpected cases of abnormal uptake, confirming further amyloid deposition. Both spherical and manual volumes of interest showed similar diagnostic performance when evaluating amyloidosis in target organs. There was no significant difference in diagnostic performance between the SUVmax, SUVmean, and SUVratio.

Conclusions 18F-florbetaben PET/CT can accurately detect systemic amyloid deposits in patients with MM. 18F-florbetaben PET/CT was particularly useful in the heart, stomach, and tongue but of limited value in the esophagus, liver, and colon. 18F-florbetaben PET/CT can provide clinical information on organ involvement and could replace pathologic examination for diagnosis of amyloidosis in the future.

From the Departments of *Nuclear Medicine

Pathology

Laboratory Medicine

§Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Received for publication April 17, 2019; revision accepted May 24, 2019.

S.H.P. and J.-C.J. contributed equally to this work.

Conflicts of interest and sources of funding: This work was financially supported by the Ulsan University Hospital Research Grant (UUH-2018-04). It was also supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (grant HI17C0904). None declared to all authors.

Correspondence to: Seol Hoon Park, MD, Department of Nuclear Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, Korea. E-mail: 79Eureka@gmail.com; and Jae-Cheol Jo, MD, PhD, Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, Korea. E-mail: jcjo97@hanmail.net.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.nuclearmed.com).

Online date: July 8, 2019

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