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Tesi etd-11162016-095615


Thesis type
Tesi di laurea specialistica LC6
Author
BERTOLAMI, WALTER
URN
etd-11162016-095615
Title
Mieloma multiplo: confronto tra la PET-CT e le tecniche di imaging convenzionali
Struttura
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
MEDICINA E CHIRURGIA
Supervisors
relatore Prof. Petrini, Mario
tutor Dott.ssa Galimberti, Sara
Parole chiave
  • 18F-fluorodeoxyglucose positron emission tomograph
  • planar radiographs
  • computed tomography
  • magnetic resonance imaging
  • bone disease
  • multiple myeloma
Data inizio appello
06/12/2016;
Consultabilità
Parziale
Data di rilascio
06/12/2019
Riassunto analitico
Multiple myeloma: a comparison between PET-CT and conventional imaging

Background
Multiple myeloma(MM) is a plasma cell neoplasia that represents one of the most frequent hematological malignancies.
Bone lesions are one of the CRAB criteria used to diagnose a symptomatic MM, fundamental for starting the treatment.
Several imaging techniques are used today to point out a bone involvement at the diagnosis and during the follow up: PET-CT is a whole body nuclear medicine imaging able to discriminate bone involvement thanks to its high sensitivity. Nevertheless, the international guidelines still don’t clearly establish that PET-CT as the gold standard technique for assessment the bone involvement and which one would be the best is still a matter of debate.

Objectives
With these premises, our single-centre retrospective trial was designed to compare PET-CT with conventional imaging methods (X-ray, CT, MRI) at the diagnosis and during the follow-up. Finally, we assessed a possible predictive and prognostic role of PET-CT in terms of quality or response and survival.

Patients and Methods
We prospectively compared 18F-FDG PET-CT with planar radiographs, CT and MRI in a series of 160 patients with diagnosed symptomatic (N=149) or smouldering multiple myeloma (SMM)(N=11).
Our patients with MM received a first line treatment with or without autologous hematopoietic stem cell transplantation according their age and co-morbidities.
Therapeutic regimens used for transplant induction or for first line treatment was essentially based on combinations containing Bortezomib, Thalidomide(± Melphalan) or Doxorubicin.
Bortezomib, lenalidomide, and melphalan were the drugs more frequently employed in patients not eligible to transplantation.



Results
We calculated for each technique sensitivity and specificity: at diagnosis, PET-CT was really superior to planar radiographs, showing a sensitivity of 75% (vs 56,25% for X-rays).
PET-CT was also superior to CT, showing sensitivity values of 100% (vs 66,66% for CT).
In contrast, both PET and MRI showed sensitivity values equal to 100%.
Similarly to what was observed at diagnosis, PET CT during follow-up showed distinct advantages in terms of sensitivity compared to X-rays (83,15% vs 60,65%, respectively).
In contrast, only a little difference between PET-CT and CT was detected during treatment (76,36% vs 75%, respectively).
On the contrary, differently from what we observed at diagnosis, a little difference in terms of sensitivity was shown in favor of MRI compared to PET CT(88,68% for MRI vs 83,93% for PET-CT).
Overall, PET CT sensitivity was significantly higher than the X-Rays sensitivity (82,18% vs 60,14%, respectively).
A little difference was observed between PET-CT and CT in terms of sensitivity (78,69 % vs 73,85 %, respectively).
No differences were observed between PET-CT and MRI(sensitivity: 90,32%).

Conclusions
PET-CT and MRI have an equivalent overall sensitivity in the assessment of bone involvement in patients with multiple myeloma.
It’s especially true at the diagnosis, where we recommend performing PET-CT for its high sensitivity and its whole-body character, supplemented by spine and pelvis MRI in presence of clinical symptoms in these areas.
During follow-up, the MRI seems to represent a good tool; however, PET-CT also provides a viable alternative, especially in the absence of clinical involvement of the spine and pelvis areas.
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