PET Scans - Multiple Myeloma Patient

JB is a 43 year old white male who was diagnosed with multiple myeloma, kappa light-chain type and renal failure in June 1993.  He responded well to chemotherapy and was in remission from 6/94 - 8/99.  Chemotherapy was repeated and remission was achieved again from 2/00 - 1/02.

Following JB's latest relapse he received chemotherapy in January and June and bone marrow transplants in February and May 2002.

A bone marrow aspirate and biopsy was performed in June 2002 which revealed an insignificant amount of residual / recurrent plasma cell myeloma, however, the bone marrow was extensively involved, grade II but progression to III was imminent.

A PET scan was ordered on 7/15/02 and a comparison was made with previous PET scans on 2/15/02 and 4/17/02, and with MR of the vertebral column performed 5/6/02.

Radiopharmaceutical:  18.6 mCi of F-18 radiolabeled FDG, IV

Comment:  Patient blood sugar at time of injection was 91 mg% with patient height being 5'11" and patient's weight 200 lbs.

Procedure: Following injection of radioisotope, imaging was performed from top of head to hips 90 minutes following injection of the radioisotope.  Emission and transmission imaging was performed with attenuation correction.  Correction was also performed for random events.  Iterative reconstructions were performed with axial, coronal, and sagittal reconstructions as well as the 3D volume rendering.  Emission imaging of the lower extremities was performed from hips to toes, also with axial, coronal, and sagittal reconstructions with 3D imaging.

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© 2002 Nuclear Education Online

Images courtesy of UAMS Dept of Nuclear Medicine.

Impression: 

1.  The abnormalities associated with the head and neck continue to demonstrate decreasing size with mild residual metabolic activity associated with the left frontotemporal fossa, vertex, and at or just inferior to the mastoid tip on the right.

2.  Incidental muscular artifact associated with the zygomatic arch on the right.

Patient received radiation treatment 9/02 to the left side of the face and head for the skin lesion that was visibly noted and detected on the 7/02 PET scan.

November 2002

JB presented in November 2002 with a chief complaint of fatigue.  Another PET scan was ordered to evaluate the progression of JB's disease.

 Click to see image

Impression:  Interval development of too numerous to count; severely active lesions throughout the axial and  appendicular skeleton.  There is no soft tissue disease seen at this time.  Particularly severe lesions include the sternum, multiple ribs, vertebral column and pelvis with the long bones involved as well.

The most severe/metabolically active regions appear to be in the sternum, with SUV measuring up to 24.3.

Teaching Note:  Standard Uptake Value (SUV) is defined as the ratio of activity in tissue per milliliter to the activity in the injected dose per patient body weight. SUV'S of greater than 2.3-2.5 are more likely to be associated with active neoplasia.  Values below those figures are more likely to be associated with inflammatory change.