RESUMO
PURPOSE: Diagnostic imaging plays a pivotal role in staging and prognostic assessment of multiple myeloma (MM) as well as planning and monitoring treatment. The aim of our study was to estimate the diagnostic accuracy of wholebody magnetic resonance imaging (WB-MRI) and positron emission tomography/computed tomography (PET/CT) in MM patients studied before and after treatment. MATERIALS AND METHODS: We considered 22 consecutive patients (10 males, 12 females; age range, 48-83 years) with newly diagnosed MM (NDMM group), and the same 22 patients underwent at least one re-assessment after treatment (previously treated MM, PTMM group). WBMRI and PET/CT were performed within days from each other in both the NDMM (22 studies) and PTMM (29 studies) group. The imaging findings were compared to the results of bone marrow aspiration. RESULTS: PET/CT was positive in 18/22 NDMM patients, whereas WB-MRI correctly identified 100% of patients. Of 20 responder patients in the PTMM group, 16 were negative at PET/CT and 12/20 at MRI. By contrast, of the nine nonresponder patients, MRI correctly detected active disease in all cases, and PET only in seven. CONCLUSIONS: WB-MRI proved superior to PET/CT in detecting MM, especially in diffuse disease. PET/CT appears to be more sensitive in the assessment of MM after treatment.
Assuntos
Imageamento por Ressonância Magnética/métodos , Mieloma Múltiplo/diagnóstico , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Imagem Corporal Total/métodos , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluordesoxiglucose F18 , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Mieloma Múltiplo/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Compostos Radiofarmacêuticos , Sensibilidade e EspecificidadeRESUMO
The anti-CD52 monoclonal antibody alemtuzumab is a highly active treatment for multiple sclerosis (MS) causing rapid depletion of B and T lymphocytes with nadir one month after last infusion. Opportunistic Cytomegalovirus (CMV) infections have been reported in MS patients treated with this drug. We report one patient who developed a CMV reactivation with hepatic involvement three weeks after the first cycle of alemtuzumab. This patient, promptly diagnosed and treated, achieved a complete recovery with valganciclovir. The possibility of this treatable opportunistic infection should be considered by neurologists in febrile patients with hepatic markers alteration after treatment with alemtuzumab.