scholarly journals Automated Whole-Body Bone Lesion Detection for Multiple Myeloma on 68Ga-Pentixafor PET/CT Imaging Using Deep Learning Methods

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Lina Xu ◽  
Giles Tetteh ◽  
Jana Lipkova ◽  
Yu Zhao ◽  
Hongwei Li ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Deep Learning ◽  
Bone Lesion ◽  
Lesion Detection ◽  
Feature Representation ◽  
Whole Body ◽  
Support Vector ◽  
Bone Lesions ◽  
Learning Methods ◽  
Pet Ct

The identification of bone lesions is crucial in the diagnostic assessment of multiple myeloma (MM). 68Ga-Pentixafor PET/CT can capture the abnormal molecular expression of CXCR-4 in addition to anatomical changes. However, whole-body detection of dozens of lesions on hybrid imaging is tedious and error prone. It is even more difficult to identify lesions with a large heterogeneity. This study employed deep learning methods to automatically combine characteristics of PET and CT for whole-body MM bone lesion detection in a 3D manner. Two convolutional neural networks (CNNs), V-Net and W-Net, were adopted to segment and detect the lesions. The feasibility of deep learning for lesion detection on 68Ga-Pentixafor PET/CT was first verified on digital phantoms generated using realistic PET simulation methods. Then the proposed methods were evaluated on real 68Ga-Pentixafor PET/CT scans of MM patients. The preliminary results showed that deep learning method can leverage multimodal information for spatial feature representation, and W-Net obtained the best result for segmentation and lesion detection. It also outperformed traditional machine learning methods such as random forest classifier (RF), k-Nearest Neighbors (k-NN), and support vector machine (SVM). The proof-of-concept study encourages further development of deep learning approach for MM lesion detection in population study.

scholarly journals Diagnostic Value of Whole-Body MRI Short Protocols in Bone Lesion Detection in Multiple Myeloma Patients

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1053
Author(s):  
Davide Ippolito ◽  
Teresa Giandola ◽  
Cesare Maino ◽  
Davide Gandola ◽  
Maria Ragusi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow Involvement ◽  
Bone Lesion ◽  
Diagnostic Value ◽  
Lesion Detection ◽  
Lower Limbs ◽  
Whole Body ◽  
Bone Lesions ◽  
Whole Body Mri ◽  
Mri Protocol

The aim of the study is to evaluate the effectiveness of short whole-body magnetic resonance imaging (WBMRI) protocols for the overall assessment of bone marrow involvement in patients with multiple myeloma (MM), in comparison with standard whole-body MRI protocol. Patients with biopsy-proven MM, who underwent a WBMRI with full-body coverage (from vertex to feet) were retrospectively enrolled. WBMRI images were independently evaluated by two expert radiologists, in terms of infiltration patterns (normal, focal, diffuse, and combined), according to location (the whole skeleton was divided into six anatomic districts: skull, spine, sternum and ribs, upper limbs, pelvis and proximal two-thirds of the femur, remaining parts of lower limbs) and lytic lesions number (<5, 5–20, and >20). The majority of patients showed focal and combined infiltration patterns with bone lesions predominantly distributed in the spine and pelvis. As skull and lower limbs are less frequently involved by focal bone lesions, excluding them from the standard MRI protocol allows to obtain a shorter protocol, maintaining a good diagnostic value.

scholarly journals Comparison of the diagnostic performance and impact on management of 18F-FDG PET/CT and whole-body MRI in multiple myeloma

2021 ◽  
Author(s):  
Olwen Westerland ◽  
◽  
Ashik Amlani ◽  
Christian Kelly-Morland ◽  
Michal Fraczek ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Data ◽  
Bone Disease ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Whole Body ◽  
Bone Lesions ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Purpose Comparative data on the impact of imaging on management is lacking for multiple myeloma. This study compared the diagnostic performance and impact on management of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and whole-body magnetic resonance imaging (WBMRI) in treatment-naive myeloma. Methods Forty-six patients undergoing 18F-FDG PET/CT and WBMRI were reviewed by a nuclear medicine physician and radiologist, respectively, for the presence of myeloma bone disease. Blinded clinical and imaging data were reviewed by two haematologists in consensus and management recorded following clinical data ± 18F-FDG PET/CT or WBMRI. Bone disease was defined using International Myeloma Working Group (IMWG) criteria and a clinical reference standard. Per-patient sensitivity for lesion detection was established. McNemar test compared management based on clinical assessment ± 18F-FDG PET/CT or WBMRI. Results Sensitivity for bone lesions was 69.6% (32/46) for 18F-FDG PET/CT (54.3% (25/46) for PET component alone) and 91.3% (42/46) for WBMRI. 27/46 (58.7%) of cases were concordant. In 19/46 patients (41.3%) WBMRI detected more focal bone lesions than 18F-FDG PET/CT. Based on clinical data alone, 32/46 (69.6%) patients would have been treated. Addition of 18F-FDG PET/CT to clinical data increased this to 40/46 (87.0%) patients (p = 0.02); and WBMRI to clinical data to 43/46 (93.5%) patients (p = 0.002). The difference in treatment decisions was not statistically significant between 18F-FDG PET/CT and WBMRI (p = 0.08). Conclusion Compared to 18F-FDG PET/CT, WBMRI had a higher per patient sensitivity for bone disease. However, treatment decisions were not statistically different and either modality would be appropriate in initial staging, depending on local availability and expertise.

Clinical implication of PET/CT and skeletal bone survey in evaluation of multiple myeloma and related monoclonal disorders.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18574-e18574
Author(s):  
Muhammad Jawad Popalzai ◽  
Homam Alkaied ◽  
Maryah Mansoor ◽  
Arnold Brenner ◽  
Qun Dai
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cell ◽  
Skeletal Survey ◽  
Whole Body ◽  
Bone Lesions ◽  
Positive Finding ◽  
Pet Ct ◽  
Plasma Cell Disorders ◽  
Smoldering Myeloma

e18574 Background: Whole body skeletal x-ray is considered a gold standard for detecting bone lesions in patients with plasma cell disorders. PET/CT has been increasingly used but its role is yet to be defined. We conducted this study to compare the role of these two imaging modalities in evaluation of plasma cell disorders. Methods: This is single institution, retrospective study to evaluate the role of skeletal survey and PET/CT in patients with multiple myeloma, smoldering myeloma and MGUS. Patients’ records, imaging reports and subsequent management plan were reviewed and compared. Results: A total of 16 patients were reviewed. Among them, 11 patients had multiple myeloma, 2 had smoldering myeloma, and 3 had MGUS. 7/11 patients with multiple myeloma had concordant findings on skeletal survey and PET. 3 of these patients had negative skeletal surveys but had positive finding on PET/CT. PET/CT also identified plasmacytomas in 2 patients. In 2 patients with smoldering myeloma, both skeletal survey and PET/CT were negative. 2/3 patients with MGUS had lytic lesions on skeletal surveys which were not revealed by subsequent PET/CT’s. Both patients were observed without treatment and at 2 years follow up did not show disease progression. Conclusions: Our retrospective analysis showed that skeletal survey is still important for base-line evaluation of bone lesions in multiple myeloma and related monoclonal disorders. PET/CT is more sensitive for detection of bone lesions and can also detect extraosseous lesions such as plasmacytomas. Using tumor metabolic activity, PET/CT may improve diagnostic accuracy and is complementary to conventional skeletal survey. [Table: see text]

Skeletal Survey in Multiple Myeloma: Role of Imaging

2021 ◽  
Vol 17 ◽  
Author(s):  
Paolo Spinnato ◽  
Giacomo Filonzi ◽  
Alberto Conficoni ◽  
Giancarlo Facchini ◽  
Federico Ponti ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Low Dose ◽  
Imaging Modality ◽  
Bone Marrow Involvement ◽  
Conventional Radiography ◽  
Response To Therapy ◽  
Whole Body ◽  
Initial Assessment ◽  
Bone Lesions ◽  
Pet Ct

: Bone disease is the hallmark of multiple myeloma. Skeletal lesions are evaluated to establish the diagnosis, to choose the therapies and also to assess the response to treatments. Due to this, imaging procedures play a key-role in the management of multiple myeloma. For decades, conventional radiography has been the standard imaging modality. Subsequently, advances in the treatment of multiple myeloma have increased the need for accurate evaluation of skeletal disease. The introduction of new high performant imaging tools, such as whole-body low dose computed tomography, different types of magnetic resonance imaging studies, and 18F-fluorodeoxyglucose positron emission tomography, replaced conventional radiography. In this review we analyze the diagnostic potentials, indications of use, and applications of the imaging tools nowadays available. Whole body low-dose CT should be considered as the imaging modality of choice for the initial assessment of multiple myeloma lytic bone lesions. MRI is the gold-standard for detection of bone marrow involvement, while PET/CT is the preferred technique in assessment of response to therapy. Both MRI and PET/CT are able to provide prognostic information.

scholarly journals Imaging in multiple myeloma: How? When?

Blood ◽  
2019 ◽  
Vol 133 (7) ◽  
pp. 644-651 ◽  
Author(s):  
Elena Zamagni ◽  
Paola Tacchetti ◽  
Michele Cavo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Multiple Myeloma ◽  
Magnetic Resonance ◽  
Imaging Modality ◽  
Response To Therapy ◽  
Whole Body ◽  
Bone Lesions ◽  
Resonance Imaging ◽  
Pet Ct

Abstract Bone disease is the most frequent feature of multiple myeloma (MM) and represents a marker of end-organ damage; it is used to establish the diagnosis and to dictate the immediate need for therapy. For this reason, imaging plays a significant role in the management of MM patients. Although conventional radiography has traditionally been the standard imaging modality, its low sensitivity in detecting osteolytic lesions and inability to evaluate response to therapy has called for the use of more sophisticated techniques, such as whole-body low-dose computed tomography (WBLDCT), whole-body magnetic resonance imaging, and 18F-fluorodeoxyglucose–positron emission tomography/computed tomography (PET/CT). In this review, the advantages, indications of use, and applications of the 3 techniques in the management of patients with MM in different settings will be discussed. The European Myeloma Network and the European Society for Medical Oncology guidelines have recommended WBLDCT as the imaging modality of choice for the initial assessment of MM-related lytic bone lesions. Magnetic resonance imaging is the gold-standard imaging modality for detection of bone marrow involvement, whereas PET/CT provides valuable prognostic data and is the preferred technique for assessment of response to therapy. Standardization of most of the techniques is ongoing.

scholarly journals Imaging of Monoclonal Gammapathy of Undetermined Significance and Smoldering Multiple Myeloma

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 486 ◽  
Author(s):  
Bastien Jamet ◽  
Clément Bailly ◽  
Thomas Carlier ◽  
Cyrille Touzeau ◽  
Anne-Victoire Michaud ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multiple Myeloma ◽  
Fdg Pet ◽  
Whole Body ◽  
Bone Lesions ◽  
Rapid Progression ◽  
Smoldering Multiple Myeloma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Undetermined Significance

Multiple myeloma (MM) is always preceded by an initial monoclonal gammopathy of undetermined significance (MGUS) that then develops into asymptomatic or smoldering multiple myeloma (SMM), which constitutes an intermediate clinical stage between MGUS and MM. According to a recent study, risk factors for faster MGUS to MM progression include an M protein of 1.5 g/dL or more and an abnormal free light chain ratio in patients with non-IgM MGUS. Therefore, the International Myeloma Working Group (IMWG) decided to recommend whole-body computed tomography (WBCT) for patients with high-risk MGUS in order to exclude early bone destruction. Studies evaluating magnetic resonance imaging (MRI) in SMM found an optimal cutoff of two or more focal lesions to be of prognostic significance for fast progression into symptomatic disease and considered this biomarker as a myeloma-defining event (MDE) needing to start therapy with the aim to avoid progression to harmful bone lesions. Moreover, studies assessing positron emission tomography (PET) with computed tomography (CT) using 18F-deoxyglucose (FDG) (FDG-PET/CT) in SMM showed that presence of focal bone lesion without underlying osteolysis is associated with a rapid progression to symptomatic MM. Latest IMWG guidelines recommended to perform WBCT (either CT alone or as part of an FDG-PET/CT protocol) as the first imaging technique at suspected SMM and, if these images are negative or inconclusive, to perform whole-body MRI. The goal of this paper is to clarify the role of different imaging modalities in MGUS and SMM workups.

scholarly journals Imaging of treatment response and minimal residual disease in multiple myeloma: state of the art WB-MRI and PET/CT

2021 ◽  
Author(s):  
Frederic E. Lecouvet ◽  
Marie-Christiane Vekemans ◽  
Thomas Van Den Berghe ◽  
Koenraad Verstraete ◽  
Thomas Kirchgesner ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Minimal Residual Disease ◽  
Fdg Pet ◽  
Residual Disease ◽  
Whole Body ◽  
Bone Lesions ◽  
Next Generation ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Minimal Residual

AbstractBone imaging has been intimately associated with the diagnosis and staging of multiple myeloma (MM) for more than 5 decades, as the presence of bone lesions indicates advanced disease and dictates treatment initiation. The methods used have been evolving, and the historical radiographic skeletal survey has been replaced by whole body CT, whole body MRI (WB-MRI) and [18F]FDG-PET/CT for the detection of bone marrow lesions and less frequent extramedullary plasmacytomas.Beyond diagnosis, imaging methods are expected to provide the clinician with evaluation of the response to treatment. Imaging techniques are consistently challenged as treatments become more and more efficient, inducing profound response, with more subtle residual disease. WB-MRI and FDG-PET/CT are the methods of choice to address these challenges, being able to assess disease progression or response and to detect “minimal” residual disease, providing key prognostic information and guiding necessary change of treatment.This paper provides an up-to-date overview of the WB-MRI and PET/CT techniques, their observations in responsive and progressive disease and their role and limitations in capturing minimal residual disease. It reviews trials assessing these techniques for response evaluation, points out the limited comparisons between both methods and highlights their complementarity with most recent molecular methods (next-generation flow cytometry, next-generation sequencing) to detect minimal residual disease. It underlines the important role of PET/MRI technology as a research tool to compare the effectiveness and complementarity of both methods to address the key clinical questions.

scholarly journals A First Report on [18F]FPRGD2 PET/CT Imaging in Multiple Myeloma

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Nadia Withofs ◽  
François Cousin ◽  
Bernard De Prijck ◽  
Christophe Bonnet ◽  
Roland Hustinx ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Fdg Pet ◽  
Low Dose ◽  
Bone Lesion ◽  
Bone Destruction ◽  
Whole Body ◽  
Newly Diagnosed ◽  
Low Dose Ct ◽  
Pet Ct ◽  
Fdg Pet Ct

An observational study was set up to assess the feasibility of [F18]FPRGD2 PET/CT for imaging patients with multiple myeloma (MM) and to compare its detection rate with low dose CT alone and combined [F18]NaF/[F18]FDG PET/CT images. Four patients (2 newly diagnosed patients and 2 with relapsed MM) were included and underwent whole-body PET/CT after injection of [F18]FPRGD2. The obtained images were compared with results of low dose CT and already available results of a combined [F18]NaF/[F18]FDG PET/CT. In total, 81 focal lesions (FLs) were detected with PET/CT and an underlying bone destruction or fracture was seen in 72 (89%) or 8 (10%) FLs, respectively. Fewer FLs (54%) were detected by [F18]FPRGD2 PET/CT compared to low dose CT (98%) or [F18]NaF/[F18]FDG PET/CT (70%) and all FLs detected with [F18]FPRGD2 PET were associated with an underlying bone lesion. In one newly diagnosed patient, more [F18]FPRGD2 positive lesions were seen than [F18]NaF/[F18]FDG positive lesions. This study suggests that [F18]FPRGD2 PET/CT might be less useful for the detection of myeloma lesions in patients with advanced disease as all FLs with [F18]FPRGD2 uptake were already detected with CT alone.

scholarly journals A prospective study comparing whole-body skeletal X-ray survey with 18F-FDG-PET/CT, 18F-NaF-PET/CT and whole-body MRI in the detection of bone lesions in multiple myeloma patients

2017 ◽  
Vol 6 (10) ◽  
pp. 205846011773880 ◽  
Author(s):  
Eva Dyrberg ◽  
Helle W. Hendel ◽  
Gina Al-Farra ◽  
Lone Balding ◽  
Vibeke B. Løgager ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Disease ◽  
Fdg Pet ◽  
Imaging Techniques ◽  
Whole Body ◽  
Bone Lesions ◽  
X Ray ◽  
Body Regions ◽  
Pet Ct ◽  
Fdg Pet Ct

Background For decades, the most widely used imaging technique for myeloma bone lesions has been a whole-body skeletal X-ray survey (WBXR), but newer promising imaging techniques are evolving. Purpose To compare WBXR with the advanced imaging techniques 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT), 18F-sodium fluoride (NaF) PET/CT and whole-body magnetic resonance imaging (WB-MRI) in the detection of myeloma bone lesions. Material and Methods Fourteen patients with newly diagnosed multiple myeloma were prospectively enrolled. In addition to WBXR, all patients underwent FDG-PET/CT, NaF-PET/CT, and WB-MRI. Experienced specialists performed blinded readings based on predefined anatomical regions and diagnostic criteria. Results In a region-based analysis, a two-sided ANOVA test showed that the extent of detected skeletal disease depends on the scanning technique ( P < 0.0001). Tukey’s multiple comparison test revealed that WB-MRI on average detects significantly more affected regions than WBXR ( P < 0.005), FDG-PET/CT ( P < 0.0001), and NaF-PET/CT ( P < 0.05). In a patient-based analysis, a Cochran’s Q test showed that there are no significant differences in the proportion of patients with bone disease detected by the different scanning techniques ( P = 0.23). Determination of intrareader variability resulted in Kappa coefficients corresponding to moderate (FDG-PET/CT) and substantial agreement (WB-MRI, WBXR, NaF-PET/CT). Conclusion WB-MRI detects on average significantly more body regions indicative of myeloma bone disease compared to WBXR, FDG-PET/CT, and NaF-PET/CT. The lack of significance in the patient-based analysis is most likely due to the small number of study participants.

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