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For both the diagnosis and assessment of Multiple Myeloma (MM) progression, 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) is routinely used, along with diffusion-weighted magnetic resonance imaging with background signal suppression (DWIBS). Both rely on exclusive properties of tumor cells compared with normal cells to detect tumor deposits and bone lesions: FDG-PET relies on increased glucose uptake and DWIBS relies on differences in water diffusion to detect changes in tissue architecture. However, discrepancies between the two methods have been observed, such that some patients with advanced disease as assessed by DWIBS were reported to be disease-free when assessed by FDG-PET – so-called ‘false negatives’.
This phenomenon was investigated by Leo Rasche and Edgardo Angtuaco from The University of Arkansas for Medical Sciences, Little Rock, AR, USA, along with collaborators from five other institutes, and their results were published in Blood in April 2017. In their study, 227 patients with newly diagnosed MM, that were transplant-eligible, were assessed simultaneously with FDG-PET and DWIBS, and additionally characterized using fluorescence in situ hybridization (FISH) and gene expression profiling (GEP).
The discrepancy between 11% of the MM patients tested that had positive results for DWIBS but were negative when assessed by FDG-PET, were linked to lower levels of hexokinase-2, which affects processing of the FDG tracer. Clinicians should be mindful of this and where possible use multiple modes of assessment; new PET tracers may also help to eliminate such false negatives. Larger studies are required to elucidate the mechanism of such a phenomenon, as well as any prognostic significance.
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