Michael E. Mulligan MD, Presenter: Nothing to Disclose

Alin Chirindel MD, Abstract Co-Author: Nothing to Disclose

Michael Karchevsky MD, Abstract Co-Author: Nothing to Disclose

To determine if FDG PET/CT can be used to discriminate between old and new pathologic fractures in myeloma patients and to determine if there are any PET/CT or MRI criteria that can help to predict an impending fracture.

Retrospective review, after IRB approval, by two musculoskeletal radiologists and one nuclear medicine physician. PET/CT database was searched to identify studies done in myeloma patients, using the search terms myeloma, plasmacytoma, or plasma cell. Records, for this group of patients, were searched for concurrent spine MR imaging and report of fracture. SUV max was recorded for each vertebral level from C2 through L5. All other imaging studies done in each patient (spine radiographs, spine CTs, spine MRIs) and clinical records were also reviewed. Spine fractures were identified using the Genant system. MRI findings noted included pattern of involvement as well as the size and location, within the vertebral body, of individual focal lesions.

30 patients were identified. Four were excluded because they had no documentation of fracture age prior to PET/CT imaging. The 26 remaining patients included 17 men and 9 women. There were a total of 59 PET/CTs, 104 spine x-ray studies, 25 spine CT exams, and 71 spine MRI exams. There were a total of 126 vertebral body fractures. 18 were determined to be new and pathologic related to active myeloma and 108 were determined to be old or due to other causes. The mean SUV max in the new pathologic fractures was 2.8 with a range from 1.1 to 4.3 (standard deviation 0.98). The old fractures had a mean SUV max of 1.6 with a range from 0.6 to 3.1 (standard deviation 0.55). This was a statistically significant difference with p value <0.0001. The combination of diffuse or multifocal vertebral body involvement on MRI and SUV >2.3 was seen in 9 of the new fracture cases.

PET/CT SUV can be used in myeloma patients to discriminate between old and new pathologic fractures just as it has been reported in other types of cancer patients. The combination of diffuse or multifocal vertebral body involvement on MRI and PET/CT SUV >2.5 may be predictive of an impending fracture.

The ability to predict an impending pathologic fracture could lead to early intervention with the hope of maintaining the patient's quality of life.

Mulligan, M, Chirindel, A, Karchevsky, M, Characterizing and Predicting Pathologic Fractures in Myeloma Patients with FDG PET/CT and MRI.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9006933.html