다발성 골수종에서 18F-FDG-PET/CT의 임상 적용
18F-FDG PET/CT in the Clinical Assessment of Patients with Multiple Myeloma: A Pilot Study
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목적:본 연구에서는 다발성 골수종 초기 진단 시에 PET/CT의 임상적 유용성을 알아보고자 하였다. 방법:새로 진단받은 다발성골수종 환자에서 초기 진단 시에 골반과 전 척추부위에 대해 MRI와 PET/CT를 모두 촬영하였다. 얻어진 영상결과의 이상유무를 비교하였고, MRI 결과와 일치하지 않은 경우가 어떤 임상적 인자와 연관이 있는지 교차 분석하였다. 결과:총 10명의 환자가 등록되었고, 중앙 연령은 57.5세였고, 대부분의 환자가 진행된 병기였으며 IgG 유형이 7명이었다. 모든 환자에서 PET/CT가 시행되었고, 경추, 흉추, 요추, 그리고 골반 부위중 36개의 부위에 대해 MRI 촬영되었다. MRI 촬영에서 대부분(69.4%) 미만성 병변이었고, 국소병변이 8.3%, 혼합된 경우가 5.6% 그리고 16.7%에서 정상소견을 보였다. MRI 영상과 비교하여 PET/CT의 일치율은 30개의 부분에서 나타나 83.3%였고, 13.9%에서 위양성 그리고 2.8%에서 위음성을 보였다. MRI와 PET/CT간의 불일치율과 임상인자 간에는 통계적으로 유의한 인자는 없었다. 결론:다발성 골수종의 골병변 평가시 PET/CT의 유용성을 정확하게 평가할 수 있는 잘 짜여진 대규모 연구가 필요할 것으로 여겨진다.
Abstract
Background/Aims:This study investigated the clinical utility of positron emission tomography/computed tomography (PET/CT) for evaluating bone lesions in patients with multiple myeloma before therapy. Methods:Whole-spine and pelvic magnetic resonance imaging (MRI) and whole-body PET/CT were conducted in patients newly diagnosed with multiple myeloma before therapy. We compared the PET/CT and MRI results for the entire spine and pelvis, and the discordance rates were cross-analyzed with the clinical factors. Results:Ten patients were enrolled (median age 57.5 years). The majority were at an advanced stage, and IgG type multiple myeloma occurred in seven patients. All patients underwent PET/CT and 36 sites were checked on MRI. Approximately 69% of the patients had diffuse patterns, 8.3% had focal lesions, 5.6% had mixed lesions, and 16.7% had a normal pattern on MRI. The concordance rate of PET/CT compared with MRI was 83.3% (30 sites). The false-positive rate was 13.9% and the false-negative rate was 2.8%. No factor predicted the discordance between the PET/CT and MRI results. Conclusions:A well-designed, large-scale study is warranted to confirm the accuracy of PET/CT for detecting bone lesions in these patients. (Korean J Med 2012;82:689-695)
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