Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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[ $^{18}F-FDG$ ] PET/CT in Multiple Myeloma: Is It Necessary to Include the Skull and Lower Extremity Distal to Mid-Thigh?

다발성 골수종에서의 $^{18}F$-FDG PET/CT: 전신영상 획득이 필요한가?

  • Lee, Su-Jin (Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Joon-Young (Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Ki-Hyun (Departments of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Eun-Jeong (Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Young-Seok (Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hyun, Seung-Hyup (Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Ji-Young (Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Kyung-Han (Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Byung-Tae (Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 이수진 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 최준영 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 김기현 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 이은정 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 조영석 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 현승협 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 이지영 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 이경한 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 김병태 (성균관대학교 의과대학 삼성서울병원 핵의학과)
  • Published : 2008.02.29
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Abstract

Purpose: We evaluated whether it was necessary to perform whole body acquisition of $^{18}F$-FDG PET/CT including whole skull and lower extremity (LE) distal to mid-thigh (MT) in patients with multiple myeloma (MM). Materials and Methods: Thirty patients underwent 45 whole body $^{18}F$-FDG PET/CT scans including skull and LE distal to MT. PET scans were divided by 2 subgroups according to the presence of abnormal focal $^{18}F$-FDG uptake in skull or LE distal to MT. Clinical characteristics including age, sex, and stages were compared between the 2 subgroups. Results: Of total 45 whole body PET/CT scans, focally increased abnormal FDG uptake in the skull or LE distal to MT suggesting myeloma involvement was found in 22 scans (48.9%) of 14 patients (46.7%). Skull lesions were more frequently observed than LE lesions distal to MT on PET (86.4% vs. 40.9%, p<0.005). There were no significant differences in age, sex, initial Durie/Salmon stage, and tumor burden at the time of PET scan suggested by serum hemoglobin level, serum calcium level, serum and urine paraprotein level, and serum creatinine level between the two subgroups. The presence of the skull or LE distal MT lesions on PET did not affect on the Durie/Salmon plus stage except only 1 case (1/22, 4.5%, p>0.05). Conclusion: Abnormal lesions in the skull or LE distal to MT on $^{18}F$-FDG PET/CT did not affect significantly on the tumor burden and Durie/Salmon plus stage of MM. Therefore, torso PET acquisition including head may be sufficient for evaluating patients with MM.

목적: 이 연구에서는 다발성 골수종에서 두개골과 중간 허벅지 이하 하지부를 포함한 전신 $^{18}F$-FDG PET/CT 영상 획득의 필요여부를 알아보았다. 대상 및 방법: 총 30명(평균나이: $59.4{\pm}11.7$세, 남/여 17/13명)의 환자를 대상으로 두개골과 중간 허벅지 이하 하지부를 포함한 전신 $^{18}F$-FDG PET/CT 영상을 총 45개 촬영하였다. PET 영상에서 두개골 또는 중간 허벅지 이하 하지부에 주변보다 비정상적인 국소 섭취증가를 보이는 병변 유무에 따라 두 그룹으로 나누어 나이, 성별, 병기 등의 임상소견 차이를 비교해보았다. 결과: 총 45개의 전신 PET/CT 영상에서 두개골 또는 중간 허벅지 이하 하지부 병변은 14명 환자(46.7%)의 22개 스캔(48.9%)에서 발견되었다. 그 중 두개골 병변은 중간 허벅지 이하 하지부 병변에 비해 유의하게 흔히 관찰되었다(86.4% 대 40.9%, p<0.005). 이 두 환자군 사이에 종양의 양을 반영하는 혈색소 수치, 혈청 칼슘 수치, 혈청 면역글로불린 수치, 뇨 면역글로불린 수치, 혈청 크레아티닌 수치에 유의한 차이는 없었다. 두개골 또는 중간 허벅지 이하 하지에 비정상적인 국소 FDG 섭취증가를 보인 22개의 PET 영상에서 두개골 또는 중간 허벅지 이하 하지 병변으로 인하여 Durie/Salmon plus 병기가 상승된 경우는 단 1개(4.5%, p>0.05)였다. 결론: FET 영상에서 두개골 또는 중간 허벅지 이하 하지 병변은 다발성 골수종에 있어 종양의 양 및 병기 평가에 유의한 영향을 주지 못했다. 따라서 다발성 골수종에서 머리와 다리를 포함한 전신영상을 꼭 촬영할 필요는 없으며, 머리를 포함한 몸통 영상획득 방법이 가장 적절할 것으로 보인다.

Keywords

References

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