***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: F18-fluorodeoxyglucose positron emission tomography ( FDG-PET ) is a powerful tool to investigate the role of tumor metabolic activity and its suppression by therapy for cancer survival . As part of Total Therapy 3 for newly diagnosed multiple myeloma , metastatic bone survey , magnetic resonance imaging , and FDG-PET scanning were evaluated in 239 untreated patients . All 3 imaging techniques showed correlations with prognostically relevant baseline parameters : the number of focal lesions ( FLs ) , especially when FDG-avid by PET-computed tomography , was positively linked to high levels of beta-2-microglobulin , C-reactive protein , and lactate dehydrogenase ; among gene expression profiling parameters , high-risk and proliferation-related parameters were positively and low-bone-disease molecular subtype inversely correlated with FL . The presence of more than 3 FDG-avid FLs , related to fundamental features of myeloma biology and genomics , was the leading independent parameter associated with inferior overall and event-free survival . Complete FDG suppression in FL before first transplantation conferred significantly better outcomes and was only opposed by gene expression profiling-defined high-risk status , which together accounted for approximately 50 % of survival variability ( R(2 ) test ) . Our results provide a rationale for testing the hypothesis that myeloma survival can be improved by altering treatment in patients in whom FDG suppression can not be achieved after induction therapy BACKGROUND AND OBJECTIVES Bone lesions in multiple myeloma ( MM ) have been traditionally detected by whole body X-ray ( WBXR ) survey although magnetic resonance imaging ( MRI ) has become the gold st and ard for detecting MM involvement of the spine and pelvis . The aim of this study was to compare a new technique , positron emission tomography ( PET ) with 18F fluorodeoxyglucose ( FDG ) integrated with computed tomography ( 18F-FDG PET-CT ) , with MRI and WBXR for baseline assessment of bone disease in MM . DESIGN AND METHODS We prospect ively compared 18F-FDG PET-CT , MRI of the spine-pelvis and WBXR in a series of 46 patients with newly diagnosed MM . In 23 patients who received up front autologous transplantation , we also compared post-treatment PET-CT scans with MR images of the spine and pelvis . RESULTS Overall , PET-CT was superior to planar radiographs in 46 % of patients , including 19 % with negative WBXR . In 30 % of patients , PET-CT scans of the spine and pelvis failed to show abnormal findings in areas in which MRI revealed an abnormal pattern of bone marrow involvement , more frequently of diffuse type . In contrast , in 35 % of patients PET-CT enabled the detection of myelomatous lesions in areas which were out of the field of view of MRI . By combining MRI of the spine- pelvis and 18F-FDG PET-CT , the ability to detect sites of active MM , both medullary and extramedullary , was as high as 92 % . Following transplantation , 15 patients had negative PET-CT scans ( including 13 with a very good partial response or at least a near complete response ) , but only 8 had normal MRI . INTERPRETATION AND CONCLUSIONS MRI of the spine and pelvis still remains the gold st and ard imaging technique for the detection of bone marrow involvement in MM . 18F-FDG PET-CT provides additional and valuable information for the assessment of myeloma bone disease in areas not covered by MRI Total therapy 3 incorporated bortezomib into a melphalan‐based t and em transplant regimen for 303 newly diagnosed patients with myeloma .  Induction chemotherapy prior to and consolidation chemotherapy after transplants each consisted of two cycles of VTD‐PACE ( bortezomib , thalidomide , dexamethasone and 4‐d continuous infusions of cis‐platin , doxorubicin , cyclophosphamide , etoposide ) ; 3‐year maintenance comprised monthly cycles of VTD in the first and TD in the remaining years . The median age was 59 years ( age > 64 years , 28 % ) . A minimum of 20 × 106 CD34 cells/kg was collected in 87 % of patients ; 83 % completed both transplants , and only 5 % suffered a treatment‐related death . At 24 months , 83 % had achieved near‐complete remission , which was sustained in 88 % at 2 years from its onset . With a median follow‐up of 20 months , 2‐year estimates of event‐free and overall survival were 84 % and 86 % respectively . The 44 patients who experienced an event more often had a high‐risk gene array profile , cytogenetic abnormalities and indicators of high lactate dehydrogenase , beta‐2‐microglobulin , creatinine and International Staging System stage . Toxicities of grade > 2 included thrombo‐embolic events in 27 % and peripheral neuropathy in 12 % . Results of this phase‐2 study demonstrated that bortezomib could be safely combined with multi‐agent chemotherapy , effecting near‐complete remission status and 2‐year survival rates in more than 80 % of patients Purpose Multiple myeloma ( MM ) is a malignant B cell and plasma cell disorder which involves the skeleton in more than 80 % of patients at diagnosis . The aim of this study was to compare whole-body X-ray ( WBXR ) , MRI and 18F-FDG PET/CT in patients with MM . Methods The study population comprised 28 newly diagnosed MM patients . Findings of 18F-FDG PET/CT were compared with those of WBXR and MRI with regard to the number and site of lesions detected . Results Comparing 18F-FDG PET/CT and WBXR , it was found that in 16/28 pts ( 57 % ) 18F-FDG PET/CT detected more lesions , all of which were located in the skeleton . Nine of these 16 patients had a completely negative WBXR survey . In 12/28 pts ( 43 % ) the two methods yielded equivalent findings . Comparing 18F-FDG PET/CT and MRI , it was found that in 7/28 pts ( 25 % ) , 18F-FDG PET/CT detected more lytic bone lesions , all of which were located outside the field of view of MRI ( bone lesions in six cases and a soft tissue lesion in one ) . In 14/28 pts ( 50 % ) , 18F-FDG PET/CT and MRI detected the same number of lesions in the spine and pelvis , while in 7/28 pts ( 25 % ) MRI detected an infiltrative pattern in the spine whereas 18F-FDG PET/CT was negative . Conclusion 18F-FDG PET/CT appears to be more sensitive than WBXR for the detection of small lytic bone lesions , whereas it has the same sensitivity as MRI in detecting bone disease of the spine and pelvis . On the other h and , MRI may be superior to 18F-FDG PET/CT in diagnosing an infiltrative pattern in the spine . Therefore , careful evaluation of MM bone disease at diagnosis should include both MRI of the spine and 18F-FDG PET/CT Methods : Dynamic positron emission tomography ( PET ) studies with F-18-deoxyglucose were performed in patients with multiple myeloma who received anthracycline-based chemotherapy  to evaluate the impact of full kinetic analysis and assess its value with regard to progression-free survival ( PFS ) . The evaluation included 19 patients ( 56 metastatic lesions ) with multiple myelomas . All patients received combined anthracycline-based chemotherapy .  PFS served as a reference for the PET data . All patients were examined prior to the onset of chemotherapy and on days 23 to 28 after the onset of the first cycle ( prior to the second cycle ) . The following parameters were retrieved from the dynamic PET studies : St and ardized Uptake Value ( SUV ) , fractal dimension ( FD ) , 2 compartment model with computation of K1 , k2 , k3 , k4 ( unit : 1/min ) , the fractional blood volume ( vB ) , and the FDG-influx according to Patlak were calculated . Results : The observed PFS varied from < 1 month to 64.1 months with a median PFS of 26 months . Most kinetic parameters demonstrated only small changes , primarily declining after 1 cycle . We compared the kinetic data of each study using a Wilcoxon matched-pairs signed rank test . The results were considered significant for P < 0.05 . The test revealed a significant change for the SUV ( z = 4.954 , P < 0.0000 ) , the FD ( z = 5.036 , P < 0.0000 ) , the fractional blood volume vB ( z = 4.116 , P < 0.0000 ) and influx ( z = 2.614 , P < 0.0090 ) when the absolute values of the first and the second study were compared . We dichotomized the patients according to the PFS of 18 months and defined 2 survival groups . The data demonstrate that the correct classification rate ( CCR ) of group 2 ( survival : > 18 months ) was generally higher ( exceeding 94 % ) than for group 1 . The use of the baseline SUV led to a CCR of 82 % for the group 2 with the longer survival . The CCR of group 1 with the short survival varied between 55 % and 70 % depending on the parameter and the study used for prediction . Furthermore , the CCR for both groups based only on the data of the second study was somewhat lower ( 74%–75 % ) as compared with the baseline FDG study ( 75%–82 % ) . Finally , the combined use of the 6 predictor variables , namely SUV , k3 , and FD ( selected by the Wilcoxon rank sum test ) of each study led to the highest CCR of 85 % for both groups . This combination was in particular useful for the prediction of group 2 with the longer survival with a CCR of 94 % . Best cutoff-values for the differentiation between short and long PFS were SUV of 4.0 and a k3 of 0.07 of the baseline study . Conclusions : The results demonstrate , that a full kinetic analysis of the FDG studies prior and after 1 chemotherapeutic cycle in patients with multiple myeloma is helpful for the prediction of PFS and may be used to identify those patients who benefit from this chemotherapeutic protocol . A high SUV ( > 4.0 SUV ) as well as a high k3 ( > 0.07 ) of the baseline study were bad prognostic parameters and related to a short PFS New imaging techniques have been introduced to assess the extent and severity of disease in multiple myeloma ( MM ) patients . The aim of our study was to compare newer imaging modalities — such as 18F-FDG PET/CT , 99mTc-methoxyisobutylisonitrile ( 99mTc-MIBI ) scintigraphy , and MRI — to assess their relative contribution in the evaluation of MM patients at diagnosis . Methods : Thirty-three newly diagnosed patients with MM were prospect ively studied . Diagnosis and staging were made according to st and ard criteria . All patients underwent whole-body 18F-FDG PET/CT , whole-body 99mTc-MIBI , and MRI of the spine and pelvis within 10 d , and imaging findings were compared . Results : 18F-FDG PET/CT was positive in 32 patients ( 16 focal uptake , 3 diffuse uptake , 13 focal and diffuse uptake ) , 99mTc-MIBI was positive in 30 patients ( 6 focal , 11 diffuse , 13 focal and diffuse uptake ) , and MRI of the spine and pelvis was positive in 27 patients ( 6 focal , 13 diffuse , 8 focal and diffuse uptake ) . 18F-FDG PET/CT showed a total of 196 focal lesions ( 178 in bones and 18 in soft tissues ) , of which 121 were in districts other than the spine and pelvis , whereas 99mTc-MIBI visualized 63 focal lesions ( 60 in bones and 3 in soft tissues ) , of which 53 were in districts other than the spine and pelvis . In the spinal and pelvic regions , 18F-FDG PET/CT detected 75 focal lesions ( 35 in spine and 40 in pelvis ) , 99mTc-MIBI visualized 10 focal lesions ( 1 in spine and 9 in pelvis ) , and MRI detected 51 focal lesions ( 40 in spine and 11 in pelvis ) . Conclusion : In whole-body analysis , 18F-FDG PET/CT performed better than 99mTc-MIBI in the detection of focal lesions , whereas 99mTc-MIBI was superior in the visualization of diffuse disease . In the spine and pelvis , MRI was comparable to 18F-FDG PET/CT and 99mTc-MIBI in the detection of focal and diffuse disease , respectively . Because myelomatous lesions may often occur out of spinal and pelvic regions , MRI should be reserved to the evaluation of bone marrow involvement of these districts , whereas 18F-FDG PET 
    Output:
    
FDG-PET or PET/CT seems to be helpful in assessing the response to treatment in patients with MM and in the evaluation of possible sites of recurrent or progressive disease