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Background  Despite the significant upgrading in recent years of the role of  18 F-FDG PET/CT in multiple myeloma (MM) diagnostics, there is a still unmet need for myeloma-specific radiotracers. 3′-Deoxy-3′-[ 18 F]fluorothymidine ( 18 F-FLT) is the most studied cellular proliferation PET agent, considered a potentially new myeloma functional imaging tracer. The aim of this pilot study was to evaluate  18 F-FLT PET/CT in imaging of MM patients, in the context of its combined use with  18 F-FDG PET/CT.    Results  Eight patients, four suffering from symptomatic MM and four suffering from smoldering MM (SMM), were enrolled in the study. All patients underwent  18 F-FDG PET/CT and  18 F-FLT PET/CT imaging by means of static (whole body) and dynamic PET/CT of the lower abdomen and pelvis (dPET/CT) in two consecutive days. The evaluation of PET/CT studies was based on qualitative evaluation, semi-quantitative (SUV) calculation, and quantitative analysis based on two-tissue compartment modeling.  18 F-FDG PET/CT demonstrated focal,  18 F-FDG avid, MM-indicative bone marrow lesions in five patients. In contrary,  18 F-FLT PET/CT showed focal,  18 F-FLT avid, myeloma-indicative lesions in only two patients. In total, 48  18 F-FDG avid, focal, MM-indicative lesions were detected with  18 F-FDG PET/CT, while 17  18 F-FLT avid, focal, MM-indicative lesions were detected with  18 F-FLT PET/CT. The number of myeloma-indicative lesions was significantly higher for  18 F-FDG PET/CT than for  18 F-FLT PET/CT. A common finding was a mismatch of focally increased  18 F-FDG uptake and reduced  18 F-FLT uptake (lower than the surrounding bone marrow). Moreover,  18 F-FLT PET/CT was characterized by high background activity in the bone marrow compartment, further complicating the evaluation of bone marrow lesions. Semi-quantitative evaluation revealed that both SUV mean  and SUV max  were significantly higher for  18 F-FLT than for  18 F-FDG in both MM lesions and reference tissue. SUV values were higher in MM lesions than in reference bone marrow for both tracers.    Conclusions  Despite the limited number of patients analyzed in this pilot study, the first results of the trial indicate that  18 F-FLT does not seem suitable as a single tracer in MM diagnostics. Further studies with a larger patient population are warranted to generalize the herein presented results.    Electronic supplementary material  The online version of this article (10.1186/s13550-018-0383-7) contains supplementary material, which is available to authorized users.

Assessment of glucose metabolism and cellular proliferation in multiple myeloma: a first report on combined 18F-FDG and 18F-FLT PET/CT imaging