11C-acetate PET/CT for metabolic characterization of multiple myeloma: a comparative study with 18F-FDG PET/CT

J Nucl Med. 2014 May;55(5):749-52. doi: 10.2967/jnumed.113.131169. Epub 2014 Mar 27.


We prospectively compared (11)C-acetate with (18)F-FDG in a PET/CT evaluation of multiple myeloma (MM), specifically on diagnostic accuracy, identification of high-risk patients, and monitoring of treatment response.

Methods: Dual-tracer PET/CT was performed on 35 pathologically and clinically confirmed and untreated patients (26 with symptomatic MM, 5 with smoldering MM, and 4 with monoclonal gammopathy of unknown significance) and 20 individuals with normal marrow.

Results: (11)C-acetate showed significant incremental value over (18)F-FDG (84.6% vs. 57.7%) for positively identifying patients with diffuse and focal symptomatic MM, and was negative in patients with indolent smoldering MM and monoclonal gammopathy of unknown significance. Three functional parameters-number of (11)C-acetate-avid and (18)F-FDG-avid focal bone lesions and (11)C-acetate general marrow activity-strongly correlated with β-2-microglobulin as surrogate imaging markers of tumor burden. After induction chemotherapy, the metabolic change in (11)C-acetate general marrow activity correlated with clinical response.

Conclusion: Metabolic characterization of MM in diagnosis, risk stratification, and treatment monitoring can be done more accurately by assessing lipid metabolism with (11)C-acetate than by assessing glucose metabolism with (18)F-FDG.

Keywords: 11C-acetate; beta-2-microglobulin; myeloma.

Publication types

  • Comparative Study

MeSH terms

  • Acetates*
  • Adult
  • Aged
  • Aged, 80 and over
  • Carbon*
  • Case-Control Studies
  • Female
  • Fluorodeoxyglucose F18*
  • Glucose / metabolism
  • Humans
  • Lipid Metabolism
  • Male
  • Middle Aged
  • Multimodal Imaging*
  • Multiple Myeloma / diagnostic imaging*
  • Paraproteinemias / diagnostic imaging
  • Positron-Emission Tomography
  • Prospective Studies
  • Radiopharmaceuticals*
  • Reproducibility of Results
  • Risk
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tumor Burden


  • Acetates
  • Radiopharmaceuticals
  • carbon-11 acetate
  • Fluorodeoxyglucose F18
  • Carbon
  • Glucose