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This study aimed to explore the correlation between imaging patterns and clinical features in patients with smoldering multiple myeloma (SMM) who simultaneously underwent 18F-FDG, 11C-Methionine, and 68Ga-Pentixafor positron emission tomography/computed tomography (PET/CT). We retrieved and analyzed clinical characteristics and PET imaging data of 10 patients with SMM. We found a significant correlation between bone marrow (BM) plasma cell (PC) infiltration and mean standardized uptake values (SUV mean ) of lumbar vertebrae L2-L4 on 11C-Methionine PET/CT scans ( r = 0.676, p = 0.031) and 68Ga-Pentixafor PET/CT scans ( r = 0.839, p = 0.002). However, there was no significant correlation between BM involvement and SUV mean of lumbar vertebrae L2-L4 on 18F-FDG PET/CT scans ( r = 0.558, p = 0.093). Similarly, mean target-to-background ratios (TBR mean ) of lumbar vertebrae L2-L4 also correlated with bone marrow plasma cell (BMPC) infiltration in 11C-Methionine PET/CT ( r = 0.789, p = 0.007) and 68Ga-Pentixafor PET/CT ( r = 0.724, p = 0.018) PET/CT. In contrast, we did not observe a significant correlation between BMPC infiltration rate and TBR mean in 18F-FDG PET/CT ( r = 0.355, p = 0.313). Additionally, on 11C-Methionine PET/CT scans, we found a significant correlation between BMPC infiltration and TBR max of lumbar vertebrae L2-L4 ( r = 0.642, p = 0.045). In conclusion, 11C-Methionine and 68Ga-Pentixafor PET/CT demonstrate higher sensitivity than 18F-FDG PET/CT in detecting BM involvement in SMM.

18F-FDG, 11C-Methionine, and 68Ga-Pentixafor PET/CT in Patients with Smoldering Multiple Myeloma: Imaging Pattern and Clinical Features