DOI: 10.1007/s00259-017-3909-8Pages: 712-719

Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe)

1. Medicina Nucleare Metropolitana, Bld 30, AOU Policlinico S. Orsola-Malpighi

2. S. Maria Nuova Hospital, Nuclear Medicine, IRCSS Reggio Emilia

3. Santa Croce e Carle Hospital, Medical Physics Division

4. Santa Croce e Carle Hospital, Nuclear Medicine

5. AOU S. Maria della Misericordia, Nuclear Medicine

6. AO Città della Salute e della Scienza, Nuclear Medicine

7. Research, Innovation and Statistics Department. A. Lacassagne Cancer Center

8. Udine University, Hematologic Clinic

9. University of Torino, Myeloma Unit, Division of Hematology

10. S. Maria Nuova Hospital, Hematology Unit, IRCCS, Reggio Emilia

11. Hematology, AOU Policlinico S. Orsola-Malpighi

Correspondence to:
Cristina Nanni
Tel: +39 051 214 3187



FDG PET/CT (18F-fluoro-deoxy-glucose positron emission tomography/computed tomography) is a useful tool to image multiple myeloma (MM). However, simple and reproducible reporting criteria are still lacking and there is the need for harmonization. Recently, a group of Italian nuclear medicine experts defined new visual descriptive criteria (Italian Myeloma criteria for Pet Use: IMPeTUs) to standardize FDG PET/CT evaluation in MM patients. The aim of this study was to assess IMPeTUs reproducibility on a large prospective cohort of MM patients.

Materials and methods

Patients affected by symptomatic MM who had performed an FDG PET/CT at baseline (PET0), after induction (PET-AI), and the end of treatment (PET-EoT) were prospectively enrolled in a multicenter trial (EMN02)(NCT01910987; MMY3033). After anonymization, PET images were uploaded in the web platform WIDEN® and hence distributed to five expert nuclear medicine reviewers for a blinded independent central review according to the IMPeTUs criteria. Consensus among reviewers was measured by the percentage of agreement and the Krippendorff’s alpha. Furthermore, on a patient-based analysis, the concordance among all the reviewers in terms of positivity or negativity of the FDG PET/CT scan was tested for different thresholds of positivity (Deauville score (DS 2, 3, 4, 5) for the main parameters (bone marrow, focal score, extra-medullary disease).


Eighty-six patients (211 FDG PET/CT scans) were included in this analysis. Median patient age was 58 years (range, 35–66 years), 45% were male, 15% of them were in stage ISS (International Staging System) III, and 42% had high-risk cytogenetics. The percentage agreement was superior to 75% for all the time points, reaching 100% of agreement in assessing the presence skull lesions after therapy. Comparable results were obtained when the agreement analysis was performed using the Krippendorff’s alpha coefficient, either in every single time point of scanning (PET0, PET-AI or PET-EoT) or overall for all the scans together. DS proved highly reproducible with the highest reproducibility for score 4.


IMPeTUs criteria proved highly reproducible and could therefore be considered as a base for harmonizing PET interpretation in multiple myeloma. A prospective clinical validation of IMPeTUs criteria is underway.

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  • Accepted: Dec 6, 2017
  • Online: Dec 21, 2017

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