The role of 68 Ga-DOTA-TATE PET/CT scanning in the evaluation of patients with multiple myeloma: preliminary results Kerim Sonmezoglu a , Betul Vatankulu a , Tugrul Elverdi b , Resit Akyel a , Melih E. Erkan e , Metin Halac a , Meltem Ocak c , Emre Demirci d and Yildiz Aydin b Objective In this observational pilot study, we aimed to evaluate the role of gallium-68-labelled DOTA-TATE ( 68 Ga-TATE) PET/computed tomography (CT) scanning in patients with multiple myeloma (MM), considering previous promising results obtained from conventional somatostatin receptor scintigraphy with 111 In pentetreotide. Materials and methods Twenty-one patients with a diagnosis of MM were prospectively included in this study: eight patients were referred for initial staging and 13 patients for restaging purpose. Both fluorine-18 fluorodeoxyglucose ( 18 F-FDG) and TATE PET/CT scanning were performed in all patients. Results All patients had one or more PET-positive lesion on either 18 F-FDG or TATE scans. Six patients had an additional diffusely increased bone marrow activity on 18 F-FDG scans, five of whom also had a concordant bone marrow appearance on TATE scans. Each PET set (either 18 F-FDG or TATE) was positive in 19 patients. There was a discordant result in four (19%) patients between 18 F-FDG and TATE scans. 18 F-FDG scans showed 112 lesions (86 TATE-positive; 26 TATE-negative) in 19 patients,whereas TATE scans showed 108 lesions (86 18 F-FDG-positive; 22 18 F-FDG-negative) in 19 patients. No significant difference was found between the two modalities in terms of lesion numbers detected (P = 0.67). However, the presence of diffuse bone marrow uptake of TATE seems to be a predicting factor for the overall survival (P = 0.033, hazard ratio: 15.2 and 95% confidence interval: 1.2–185.5). Conclusion TATE PET/CT seems to be an alternative imaging modality and may play a complementary role in MM management, at least by providing a different pathobiological insight into the disease. Nucl Med Commun 38:76–83 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Nuclear Medicine Communications 2017, 38:76–83 Keywords: gallium-68 DOTA-TATE, fluorine-18 fluorodeoxyglucose, multiple myeloma, PET/CT, plasmacytoma, somatostatin receptor scintigraphy a Department of Nuclear Medicine, b Department of Internal Medicine, Haematology Division, Cerrahpasa Medical Faculty, c Department of Pharmaceutical Technology, Faculty of Pharmacy, Istanbul University, d Sisli Etfal Education and Training Hospital, Istanbul and e Department of Nuclear Medicine, Medical Faculty, Konuralp, Duzce University, Duzce, Turkey Correspondence to Kerim Sönmezoğlu, MD, Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, 34303 Aksaray, Istanbul, Turkey Tel: + 90 212 414 31 08; fax: + 90 212 414 31 07; e-mails: kerimsonmezoglu@yahoo.com, drkerim@istanbul.edu.tr Received 29 May 2016 Revised 1 August 2016 Accepted 3 October 2016 Introduction Multiple myeloma (MM) is a neoplasm of plasma B cells characterized by bone marrow infiltration with an over- production of a monoclonal plasma cell population and immunoglobulin, invariably resulting in skeleton abnormalities along with hypercalcaemia and kidney dysfunction [1]. Assessment of osseous involvement is one of the most difficult challenges as it develops either at the initial management or during follow-up and is either represented by diffuse osteoporosis secondary to diffuse marrow infiltration of plasma cells or more fre- quently focal osteolytic bone lesions because of increased bone resorption and reduced bone formation [2]. Although whole-body skeletal radiography and/or computed tomography (CT) scans are the primary techniques to detect bone lesions of MM, their sensi- tivity is relatively low, particularly in the early phase of the disease, because of the requirement of at least 30% of the trabecular bone lost for revealing the lesions [3]. MRI is a more sensitive modality and particularly useful in the detection of bone marrow infiltration [4]. However, its limitations are described in the literature [5–9]. In contrast, various scintigraphic techniques have emerged to assess disease activity of MM and may overcome some limitations of radiological methods. For example, 99m Tc sestamibi and fluorine-18 fluorodeoxy- glucose ( 18 F-FDG)-PET imaging are capable of identi- fying the metabolic activity of the malignant plasma cells and have been shown to be useful modalities in the management of MM [10,11]. In particular, 18 F-FDG imaging using combined PET/CT scanners has gained popularity in imaging of MM in recent years taking advantage of simultaneous metabolic and morphological imaging in one examination with high-resolution Original article 0143-3636 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MNM.0000000000000610 Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved.