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Multiple Myeloma: Molecular Imaging with ¹¹C-Methionine PET/CT—Initial Experience¹

¹ From the Departments of Nuclear Medicine (A.D., G.G., C.F., N.M.B., D.K., S.N.R.) and Internal Medicine III (P.L., C.W., D.B.), University of Ulm, Robert-Koch-Strasse 8, D-89081 Ulm, Germany. Received December 7, 2005; revision requested January 19, 2006; revision received February 20; accepted March 10; final version accepted May 1. Address correspondence to S.N.R. (e-mail: sven.reske{at}uniklinik-ulm.de).

Purpose: To prospectively assess molecular imaging of multiple myeloma (MM) by using the radiolabeled amino acid carbon 11 (¹¹C) methionine and positron emission tomography (PET)/computed tomography (CT).

Materials and Methods: The study was approved by the institutional local ethics committee and the national radiation protection authorities. All patients with MM and control patients gave written informed consent. Nineteen patients with MM (11 women, eight men; age range, 42–64 years) and 10 control patients with hyperparathyroidism without hematologic diseases (six women, four men; age range, 43–75 years) underwent PET/CT 20 minutes after injection of a mean of 1.0 GBq ± 0.2 (standard deviation) ¹¹C-methionine. Presence and extent of CT-assessed tumor manifestations and ¹¹C-methionine bone marrow (BM) uptake were determined on the basis of maximum standardized uptake value (SUV_max). BM imaging patterns, normal BM, and maximal lesion ¹¹C-methionine uptake in patients with MM were compared with those in control patients. In two patients with MM, sulfur 35 (³⁵S) methionine uptake in freshly isolated BM plasma cells was measured. Values for SUV_max of groups were compared by using the Mann-Whitney test on a per-patient basis.

Results: ³⁵S-methionine uptake of plasma cells was five- to sixfold higher than in normal BM cells. ¹¹C-methionine BM uptake in control patients was homogeneous and low. All patients with MM except one with exclusively extramedullary myeloma had ¹¹C-methionine–positive lesions. Maximal lesion and normal BM ¹¹C-methionine mean SUV_max were 10.2 ± 3.5 and 4.3 ± 2.0, respectively, and thus were significantly higher than that of BM in the control group (mean, 1.8 ± 0.3; P < .001). Extramedullary MM was clearly visible in three patients (mean SUV_max, 7.2 ± 2.4). Additional ¹¹C-methionine–positive lesions in normal cancellous bone were found in nearly all patients with MM. In pretreated patients with MM, a moderate fraction of osteolytic lesions had no ¹¹C-methionine uptake.

Conclusion: On the basis of increased methionine uptake in plasma cells, active MM can be imaged with ¹¹C-methionine PET/CT.

© RSNA, 2006