Progression to symptomatic multiple myeloma predicted by texture analysis-derived parameters in patients without focal disease at 18F-FDG PET/CT

ABSTRACT Objective : Aim of the study was to determine whether PET parameters derived from texture analysis of axial and peripheral skeleton predict progression to symptomatic multiple myeloma (MM) in patients undergoing 18F-FDG PET/CT, without evidence of focal sites of 18F-FDG uptake. Methods : patients with smouldering MM undergoing 18F-FDG PET/CT from May 2014 to June 2018 were retrospectively reviewed. VOIs were placed on T5-T7 and L2-L4, iliac crests and femoral diaphyses. A dedicated software (LIFEx®,www.lifexsoft.org) allowed to obtain PET-derived first, second and higher order texture features. Possible association between PET parameters and progression to symptomatic MM was determined; Kaplan-Meier curves allowed to assess time to progression (TTP) according to PET parameters. Results : 45 patients were included: 26/45 (58%) patients never met criteria for symptomatic MM, while 19/45 (42%) patients progressed to symptomatic MM. Several texture features extracted from VOIs placed on iliac crests and femoral diaphyses were significantly associated with progression to symptomatic MM and with a shorter TTP (P Conclusion : PET texture-derived features may be expression of subtle disease distribution in the axial and peripheral bone marrow. MICRO-ABSTRACT : The present retrospective study is focused on the possible clinical implications of texture analysis-derived PET parameters in patients with smouldering multiple myeloma; several texture features are significantly associated with progression to symptomatic multiple myeloma and with a shorter time to progression; these results may lead to early identification of patients who could benefit from specific therapies.