Mnohočetný myelom je krevní nádorové onemocnění charakterizované proliferací klonálních plasmatických buněk v kostní dřeni a přítomností paraproteinu v séru a/nebo moči. V posledních letech se pro diagnostiku i pro celý průběh léčby dostává do popředí celotělová zobrazovací metoda pozitronová emisní tomografie (PET) kombinovaná s výpočetní tomografií (PET/CT). Její výhodou je zachycení metabolicky aktivních charakteristických ložisek a dobrá detekce extramedulárních i paramedulárních lézí. Následující text shrnuje společné stanovisko odborníků České společnosti nukleární medicíny ČLS JEP z. s. (ČSNM ČLS JEP) a České myelomové skupiny (CMG) jak k provedení vyšetření PET/CT, tak k jeho hodnocení a reportování. Cílem je sjednotit metodiku vyšetření PET/CT napříč pracovišti v ČR, která bude srozumitelná a jednoznačná.
Multiple myeloma is a blood cancer characterized by proliferation of clonal plasma cells in the bone marrow and the presence of paraprotein in the serum and/or urine. In recent years, whole-body positron emission tomography (PET) imaging combined with computed tomography (PET/CT) has become a preferred imaging technique for diagnosis and treatment. It has the benefit of detecting metabolically active characteristic focuses and good detection of extramedullary and paramedullary lesions. The following text presents the collective opinion of the representatives of the Czech Society of Nuclear Medicine ČLS JEP z.s. (CSNM ČLS JEP) and the Czech Myeloma Group (CMG) on PET/CT as well as on its evaluation and reporting. The aim is to standardize the methodology of PET/CT examination across the Czech Republic, which will be clear and simple to understand.
- Keywords
- extramedulární ložiska, paramedulární ložiska,
- MeSH
- Response Evaluation Criteria in Solid Tumors MeSH
- Humans MeSH
- Multiple Myeloma * diagnostic imaging MeSH
- Positron Emission Tomography Computed Tomography methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Practice Guideline MeSH
Mnohočetný myelom je krevní nádorové onemocnění charakterizované proliferací klonálních plazmatických buněk v kostní dřeni a přítomností paraproteinu v séru a/nebo moči. V posledních letech se pro diagnostiku i pro celý průběh léčby dostává do popředí celotělová zobrazovací metoda pozitronová emisní tomografie (PET) kombinovaná s výpočetní tomografií (PET/CT). Její výhodou je zachycení metabolicky aktivních charakteristických ložisek a dobrá detekce extramedulárních i paramedulárních lézí. Následující text shrnuje společné stanovisko odborníků České společnosti nukleární medicíny ČLS JEP (ČSNM ČLS JEP) a České myelomové skupiny (CMG) jak k provedení vyšetření PET/CT, tak k jeho hodnocení a reportování. Cílem je sjednotit metodiku vyšetření PET/CT napříč pracovišti v ČR, která bude srozumitelná a jednoznačná.
Multiple myeloma is a blood cancer characterized by proliferation of clonal plasma cells in the bone marrow and the presence of paraprotein in the serum and/or urine. In recent years, whole-body positron emission tomography (PET) imaging combined with computed tomography (PET/CT) has become a preferred imaging technique for diagnosis and treatment. It has the benefit of detecting metabolically active characteristic focuses and good detection of extramedullary and para-medullary lesions. The following text presents the joint standpoint of the representatives of the Czech Society of Nuclear Medicine ČLS JEP (CSNM ČLS JEP) and the Czech Myeloma Group (CMG) regarding PET/CT examination per se as well as its evaluation and reporting. The aim is to standardize the methodology of PET/CT examination across the Czech Republic, which will be clear and simple to understand.
- MeSH
- Fluorodeoxyglucose F18 MeSH
- Humans MeSH
- Multiple Myeloma * diagnostic imaging pathology MeSH
- Positron Emission Tomography Computed Tomography * methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Practice Guideline MeSH
- Geographicals
- Czech Republic MeSH
OBJECTIVES: In multiple myeloma and its precursor stages, plasma cell infiltration (PCI) and cytogenetic aberrations are important for staging, risk stratification, and response assessment. However, invasive bone marrow (BM) biopsies cannot be performed frequently and multifocally to assess the spatially heterogenous tumor tissue. Therefore, the goal of this study was to establish an automated framework to predict local BM biopsy results from magnetic resonance imaging (MRI). MATERIALS AND METHODS: This retrospective multicentric study used data from center 1 for algorithm training and internal testing, and data from center 2 to 8 for external testing. An nnU-Net was trained for automated segmentation of pelvic BM from T1-weighted whole-body MRI. Radiomics features were extracted from these segmentations, and random forest models were trained to predict PCI and the presence or absence of cytogenetic aberrations. Pearson correlation coefficient and the area under the receiver operating characteristic were used to evaluate the prediction performance for PCI and cytogenetic aberrations, respectively. RESULTS: A total of 672 MRIs from 512 patients (median age, 61 years; interquartile range, 53-67 years; 307 men) from 8 centers and 370 corresponding BM biopsies were included. The predicted PCI from the best model was significantly correlated ( P ≤ 0.01) to the actual PCI from biopsy in all internal and external test sets (internal test set: r = 0.71 [0.51, 0.83]; center 2, high-quality test set: r = 0.45 [0.12, 0.69]; center 2, other test set: r = 0.30 [0.07, 0.49]; multicenter test set: r = 0.57 [0.30, 0.76]). The areas under the receiver operating characteristic of the prediction models for the different cytogenetic aberrations ranged from 0.57 to 0.76 for the internal test set, but no model generalized well to all 3 external test sets. CONCLUSIONS: The automated image analysis framework established in this study allows for noninvasive prediction of a surrogate parameter for PCI, which is significantly correlated to the actual PCI from BM biopsy.
- MeSH
- Biopsy MeSH
- Chromosome Aberrations MeSH
- Deep Learning * MeSH
- Bone Marrow diagnostic imaging MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Multiple Myeloma * diagnostic imaging genetics MeSH
- Retrospective Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Common Variable Immunodeficiency diagnosis etiology complications mortality pathology MeSH
- Diagnosis, Differential MeSH
- Middle Aged MeSH
- Humans MeSH
- Multiple Myeloma * diagnostic imaging drug therapy blood mortality pathology MeSH
- Paraproteinemias blood MeSH
- Sepsis diagnosis drug therapy complications MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
Objective: Retrospective evaluation of the results of operating treatment in patients with multiple myeloma (MM) with pathological fracture of the long bone treated by the stable osteosynthesis (OS) at the Trauma Clinic of the University Hospital Brno in the period from January 2013 to December 2018. Material and methods: Retrospective evaluation of the set of 410 patients treated with MM at the University Hospital Brno in the period of 2013–2018. Both inclusion and exclusion criteria were determined. The method of the performed osteosynthesis of a pathological fracture of the long bone depended on its localisation. It was either a nailing or plating osteosynthesis with stabilisation using the Prevotʼs rods. The following was evaluated on the acquired set of patients. Epidemiology data, fracture occurrence mechanism and type of fracture, intensity of pain, Mirels´ score, type of the osteosynthesis used, time section from determination of the MM diagnosis to occurrence of the fracture and also from the performed osteosynthesis to the healing of the fracture, and any treatment complications, if appropriate. Results: Following the satisfaction of the inclusion and exclusion criteria, a set was formed of 24 patients with MM, who suffered a total of 32 pathological fractures of long bones in the myeloma deposits and were treated using the osteosynthesis method. 11 men and 13 women were represented in the set. The average age of the monitored patients was 71 years. Fractures were localized in 20 cases into the region of diaphysis and proximal humerus, once into the radial area, and in 11 cases into the femoral area. Nailing osteosynthesis was used in 26 fractures (82 %), plating osteosynthesis was used in 5 fractures (15 %), and Prevotʼs rods were used in 1 case (3 %). In correlation with the used osteosynthesis method, we reported the healing of the fracture with a bony callus in 29 cases (91 %), in 2 cases (6 %) the direct healing, and 1 fracture did not heal and a false joint was formed (3 %). The following complications occurred during the treatment in 23 patients: periimplant fracture (N=2), and proximalisation of humeral nail with interference into subacromial space (N=1). Conclusion: MM represents a serious hematologic disease. Unlike in metastatic affection of bones with solid tumours, performance of stable osteosynthesis is indicated in respect of myeloma bone disease in the case of a pathological fracture of long bones, which does not exclude simultaneous systemic treatment of MM or radiotherapy.
- MeSH
- Fractures, Spontaneous surgery complications MeSH
- Bone and Bones surgery MeSH
- Middle Aged MeSH
- Humans MeSH
- Multiple Myeloma * surgery diagnostic imaging complications MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Fracture Fixation, Internal * methods statistics & numerical data MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Publication type
- Evaluation Study MeSH
Monoclonal gammopathy of undetermined significance (MGUS) is a known precursor of more serious cancers, such as multiple myeloma (MM), Waldenström macroglobulinemia (MW) and other lymphoproliferative disorders. Using 18F-FDG PET/CT, we aimed to evaluate its benefit in early detection of various accompanying disorders and illnesses in MGUS patients. We prospectively analyzed the diagnostic relevance of 18F-FDG PET/CT in 390 newly diagnosed MGUS patients. On 18F-FDG PET/CT scans, the presence of focal or diffuse areas of detectable increased tracer uptake was recorded in 37 (9.5%) MGUS patients. The most frequent pathology was lymphadenopathy (3.8%), followed by thyroid diseases (2.1%), rheumatic diseases (1.8%), and other solid malignancies (1.5%). These results have major implications for confirmed associations of MGUS with numerous malignant and non-malignant disorders. We believe that 18F-FDG PET/CT imaging in newly diagnosed MGUS patients may be useful in early detection of other serious pathologies, not only in predicting progression of MGUS to active MM, and should be strongly recommended if available.
- MeSH
- Adult MeSH
- Fluorodeoxyglucose F18 MeSH
- Humans MeSH
- Multiple Myeloma * diagnostic imaging MeSH
- Monoclonal Gammopathy of Undetermined Significance * diagnostic imaging MeSH
- Positron Emission Tomography Computed Tomography MeSH
- Positron-Emission Tomography MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
Cíl: Retrospektivní zhodnocení výsledků operační léčby u pacientů s mnohočetným myelomem (MM) a patologickou frakturou dlouhé kosti léčených metodou stabilní osteosyntézy (OS) na Klinice úrazové chirurgie FN Brno v období leden 2013 až prosinec 2018. Materiál a metody: Retrospektivní zhodnocení souboru 410 pacientů léčených s MM ve FN Brno za období 2013–2018. Byla stanovena inkluzní a exkluzní kritéria. Způsob provedené OS patologické zlomeniny dlouhé kosti záležel na její lokalizaci. Jednalo se buď o hřebovou nebo dlahovou OS či stabilizaci pomocí Prevotových prutů. Na získaném souboru pacientů byla hodnocena základní epidemiologická data, mechanizmus vzniku a typ zlomeniny, intenzita bolesti, Mirelsovo skóre, typ použité OS, časový úsek od stanovení diagnózy MM ke vzniku zlomeniny a také od provedení osteosyntézy po zhojení fraktury a případné komplikace léčby. Výsledky: Po splnění inkluzních a exkluzních kritérií vznikl soubor 24 pacientů s MM, kteří utrpěli celkem 32 patologických fraktur dlouhých kostí v myelomových ložiscích a byli ošetřeni metodou osteosyntézy. V souboru bylo zastoupeno 11 mužů a 13 žen. Průměrný věk všech sledovaných byl 71 let. Zlomeniny byly lokalizovány ve 20 případech do oblasti diafýzy a proximálního humeru, jedenkrát do oblasti radia, v 11 případech pak do oblasti femuru. Hřebová osteosyntéza byla využita u 26 zlomenin (82 %), dlahová OS u pěti zlomenin (15 %) a Prevotovy pruty v jednom případě (3 %). V korelaci s použitou metodou osteosyntézy jsme zaznamenali ve 29 případech sekundárního hojení zlomeniny kostěným svalkem (91 %), ve dvou případech (6 %) direktního hojení a jedna zlomenina se nezahojila a vznikl pakloub (3 %). V průběhu léčby se u 23 pacientů vyskytly následující komplikace: periimplantátová fraktura (N=2), a proximalizace humerálního hřebu se zasahováním do subakromiálního prostoru (N=1). Závěr: MM představuje závažné hematologické onemocnění. Oproti metastatickému postižení kostí solidními tumory je v případě myelomové kostní nemoci u patologické zlomeniny dlouhých kostí indikováno provedení stabilní osteosyntézy, nevylučující souběžnou systémovou léčbu MM či radioterapii.
- MeSH
- Fractures, Spontaneous surgery complications MeSH
- Bone and Bones surgery MeSH
- Middle Aged MeSH
- Humans MeSH
- Multiple Myeloma * surgery diagnostic imaging complications MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Fracture Fixation, Internal * methods statistics & numerical data MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Publication type
- Evaluation Study MeSH
Mnohočetný myelom je druhým nejčastějším krevním nádorem. V přehledném článku je posouzen vývoj v oblasti diagnostiky, prognostiky a strategie léčby během posledních 25 let. Zvláště v poslední dekádě patří mnohočetný myelom mezi nádorové onemocnění s největší dynamikou rozvoje léčebných strategií. Na základě průkazného pokroku a dlouhodobých výsledků již dnes hovoříme o vyléčitelnosti nemocných s mnohočetným myelomem. Podíl vyléčitelných nemocných bude stoupat s dostupností léčebných možností s prokázanou účinností v randomizovaných studiích.
Multiple myeloma is the second most frequent blood malignancy. This review examines developments in diagnostics, prognosis and treatment strategies over the past 25 years. The past decade alone has seen multiple myeloma rank among cancers with the greatest dynamics in treatment strategies. Based on clear progress and long-term results, we may now consider patients with multiple myeloma to be potentially curable. The proportion of curable patients will increase with the availability of the treatment options of proven efficacy in randomized trials.
- MeSH
- In Situ Hybridization, Fluorescence MeSH
- Humans MeSH
- Multiple Myeloma * diagnostic imaging diagnosis therapy MeSH
- Prognosis MeSH
- Flow Cytometry MeSH
- Radiography MeSH
- Neoplasm Staging MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Bortezomib administration & dosage MeSH
- Dexamethasone administration & dosage MeSH
- Induction Chemotherapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Multiple Myeloma * diagnostic imaging drug therapy blood MeSH
- Antibodies, Monoclonal administration & dosage pharmacology adverse effects MeSH
- Treatment Failure MeSH
- Recurrence MeSH
- Neoplasm Grading MeSH
- Thalidomide analogs & derivatives administration & dosage MeSH
- Hematopoietic Stem Cell Transplantation MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Our limited experience suggests that fluorine-18-fluorocholine (18F-FCH) may perform better in the detection of skeletal involvement by multiple myeloma compared to fluorine-18-fluorodeoxyglucose (18F-FDG) and that standard uptake ratio (SUR) might be considered in the semi-quantitative comparison of tracer uptake.
- MeSH
- Choline analogs & derivatives MeSH
- Muscle, Skeletal diagnostic imaging pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Multiple Myeloma diagnostic imaging pathology MeSH
- Positron Emission Tomography Computed Tomography * MeSH
- Feasibility Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
