ArticleEuropean journal of nuclear medicine and molecular imaging2026
Diagnostic brain-to-liver [
Article in European journal of nuclear medicine and molecular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purpose[¹⁸F]FDG PET/CT has been widely used in oncology for diagnosis and treatment monitoring. Reduced cerebral [¹⁸F]FDG uptake has been observed in patients with disseminated malignancies, potentially associated with the Warburg effect and elevated lactate levels. This study investigated the prognostic relevance of the brain-to-liver [¹⁸F]FDG uptake ratio (BLR) in MM patients who underwent PET/CT at diagnosis.
methodsBLR was calculated as the ratio between the mean standardized uptake value (SUV) of the whole brain and that of the liver. A total of 72 patients were retrospectively included in the study (58% male; median age 65 years (IQR55;70); 67% were classified as ISS stage III).
resultsBLR, as a continuous variable, showed a statistically significant difference between groups according to sex (p = 0.004), overweight status (p = 0.005), and ISS stage (p = 0.03), and was negatively correlated with β₂-microglobulin (r= - 0.42, p < 0.001). With a median follow-up of 23 months (IQR 8; 65), 74% patients had died from MM-related causes. Patients with BLR > 2.7 demonstrated superior 60-month overall survival (52%vs.10%, p = 0.002) and progression-free survival (19%vs.3%, p = 0.003), respectively. Multivariate Cox regression confirmed BLR (HR 1.86 95%CI: 1.03-3.33, p = 0.038 (OS); HR 1.93 95%CI: 1.13-3.29, p = 0.016 (PFS))as an independent factor and the use of autologous hematopoietic cell transplantation (HCT) as consolidation for both OS and PFS. In addition, ISS stage III was also a prognostic factor for OS.
conclusionHigher brain-to-liver [¹⁸F]FDG uptake ratio (> 2.7) at diagnosis predicts better clinical outcomes in multiple myeloma. BLR is significantly associated with established clinical markers of tumor burden in multiple myeloma. These findings suggest that BLR is a feasible and reproducible metric with potential prognostic value in multiple myeloma.
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