scholarly journals PET/CT imaging in polymyalgia rheumatica: praepubic 18F-FDG uptake correlates with pectineus and adductor longus muscles enthesitis and with tenosynovitis

2017 ◽  
Vol 51 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Zdenek Rehak ◽  
Andrea Sprlakova-Pukova ◽  
Zbynek Bortlicek ◽  
Zdenek Fojtik ◽  
Tomas Kazda ◽  
...  
Keyword(s):  
Polymyalgia Rheumatica ◽  
Fdg Pet ◽  
Response To Therapy ◽  
Emission Computed Tomography ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Adductor Longus ◽  
Fdg Accumulation

Abstract Background The role of 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) is increasing in the diagnosis of polymyalgia rheumatica (PMR), one of the most common inflammatory rheumatic diseases. In addition to other locations, increased 18F-FDG accumulation has been detected in the praepubic region in some patients. However, a deeper description and pathophysiological explanation of this increased praepubic accumulation has been lacking. The aim of the presented study is to confirm a decrease in praepubic 18F-FDG accumulation in response to therapy and to describe potential correlations to other 18F-FDG PET/CT scan characteristics during the course of disease. As a secondary objective, we describe the pathological aspects of the observed praepubic 18F-FDG uptake. Patients and methods A retrospective review of patients with newly suspected PMR undergoing baseline and follow up 18F-FDG PET/CT between February 2010 and March 2016 is given. Those with a visually detected presence of praepubic 18F-FDG accumulation were further analysed. The uptake was assessed visually and also semi-quantitatively in the defined region of interest by calculation of target-to-liver ratios. Other regions typical for PMR were systematically described as well (shoulders, hips, sternoclavicular joints, ischiogluteal bursae, spinous interspaces). Results Twenty-three out of 89 screened patients (26%) presented with initial praepubic 18F-FDG PET/CT positivity, 15 of whom also underwent follow up 18F-FDG PET/CT examination. Five out of 15 patients presented with increased 18F-FDG accumulation in large arteries as a sign of giant cell arteritis. During follow up examination, decrease in 18F-FDG accumulation caused by therapeutic intervention was observed in all evaluated locations in all analysed patients and no new positivity was indicated, including periarticular, extraarticular tissues or target large vessels. Praepubical accumulation of 18F-FDG was diminished in all patients (15/15, 100%) after treatment with steroids. Conclusions Increased praepubic 18F-FDG uptake in patients with PMR is relatively common and this region should be systematically evaluated during differential diagnosis of rheumatic and malignant disease. Praepubic inflammation is probably related to enthesitis and tenosynovitis at the origin of pectineus and adductor longus muscles ventrally from the pubis.

scholarly journals Quantitative analysis of myocardial metabolic heterogeneity is superior to visual assessment for the detection of active cardiac sarcoidosis by F-18 FDG PET-CT imaging

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Malik ◽  
M Yazdani ◽  
SM Gould ◽  
E Reyes
Keyword(s):  
Fdg Pet ◽  
Cardiac Sarcoidosis ◽  
Visual Assessment ◽  
Ct Imaging ◽  
Myocardial Inflammation ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Metabolic Heterogeneity ◽  
Fdg Pet Ct

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial inflammation may occur in the context of a multisystem disease such as sarcoidosis, adversely affecting prognosis. A definitive diagnosis of cardiac sarcoidosis (CS) is essential to implementing life-saving treatment but this is complicated by the invasive nature of endomyocardial biopsy (EMB) and its low accuracy. Positron emission tomography (PET) assists in diagnosis, which relies on visual interpretation of myocardial F-18 FDG uptake. The value of quantitative analysis and its application to clinical practice remain uncertain. Purpose To investigate the power of quantitative F-18 FDG PET-CT imaging analysis for detecting CS in patients with suspected disease. Methods All patients underwent F-18 FDG PET-CT after a 24-hour low-carbohydrate diet and 15-hour fasting as part of their diagnostic work-up for suspected cardiac inflammation. Cardiovascular magnetic resonance acted as gatekeeper to PET-CT in 8 of every 10 scans. Myocardial F-18 FDG uptake was assessed qualitatively and quantitatively using both manually drawn regions of interest and automatic polar maps to measure global and segmental standardised F-18 FDG uptake values (SUV).  The coefficient of variation (CoV) was calculated to determine uptake heterogeneity. To confirm diagnosis, follow-up data regarding disease progression, further testing and treatment were collected. To allow for sufficient follow-up time, the first 40 consecutive patients from a prospective registry (n= 214; Sep 2017-Jun 2020) were included. Results A comprehensive clinical picture was obtained successfully in 37 patients (median [IQR], 17 [13.5] months) and a final diagnosis of CS reached in 7 (disease prevalence, 19%). EMB was performed in 2 patients only while 3 underwent PPM/ICD implantation. Significant predictors of CS were fulfilment of Japanese Ministry of Health and Welfare criteria (Wald, 6.44; p = 0.01) and left ventricular dysfunction (Wald 6.72; p = 0.01). Qualitative F-18 FDG PET-CT had a high negative (95%) but low positive (45%) predictive value for CS (sensitivity, 83%; specificity, 77%). F-18 FDG SUV CoV was the strongest imaging predictor (Wald, 6.77; p = 0.009) and was significantly higher in CS than non-CS (CoV median [quartiles], 0.26 [0.21, 0.36] and 0.12 [0.11, 0.14] respectively; p = 0.004). As per ROC curve analysis (AUC, 0.84), a CoV threshold of 0.20 was highly specific (93%) and sensitive (86%) for CS. Conclusion In a referring population with a low prevalence of cardiac sarcoidosis, F-18 FDG PET-CT imaging is sensitive for the detection of myocardial inflammation with active disease unlikely in patients with a negative scan. Quantitative evaluation of metabolic heterogeneity within the myocardium provides a strong, independent marker of active disease and should be considered alongside visual assessment.

Abstract 12920: The Value of 18 FDG PET/CT in the Diagnostic Work-Up of Patients With Possible Infective Endocarditis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fabio Chirillo ◽  
Franco Boccaletto ◽  
Paola Pantano ◽  
Alessandro De Leo ◽  
Marta Possamai ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Clinical Judgment ◽  
Predictive Value ◽  
Fdg Pet ◽  
Blood Cultures ◽  
Fdg Uptake ◽  
Duke Criteria ◽  
Pet Ct ◽  
Fdg Pet Ct

The diagnosis of infective endocarditis (IE) is sometimes difficult when there are discrepancies between blood cultures, transesophageal echocardiography (TEE) and clinical judgment. The aim of this study was to assess the incremental diagnostic value of 18 F-FDG-PET/CT in 45 consecutive patients (73% male, mean age 61 ± 26 years) with suspected IE and inconclusive tests at admission. In 28 patients (19 with a cardiac valvular (15) or nonvalvular (4) device) with blood cultures positive for germs typically involved in IE the initial TEE was negative or inconclusive. In 10 patients presenting with fever TEE identified cardiac lesion possibly related to IE (ruptured mitral chordae, thickened valve leaflet, thickened prosthetic annulus), but blood cultures were persistently negative. Finally, 7 patients had metastatic or embolic lesions and a predisposing cardiac condition, but TEE was negative. When previous unknown lesions detected by PET/CT were confirmed by succeeding examinations, they were considered true positives. When PET/CT was negative, it was compared with the final diagnosis that was defined according to the modified Duke criteria determined during a 6-month follow-up. Thirty patients had definite IE at the end of the follow-up, 3 had possible IE, and in 12 patients the diagnosis was rejected. Twenty-seven patients (60%) exhibited abnormal FDG uptake around the cardiac valves, and 12 (27%) had extracardiac accumulation. In 5 patients the initial negative TEE became positive a mean 5 ±7 days after PET/CT had been performed The sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT were as follows (95% confidence interval): 87% (68% to 95%), 67% (38% to 87%), 84% (65% to 94%), and 71% (42% to 92%), respectively. Adding abnormal FDG uptake as a new major criterion significantly increased the sensitivity of the modified Duke criteria at admission (68% [53% to 82%] vs. 96% [88% to 99%], p = 0.01). This result was due to a significant reduction (p < 0.001) in the number of possible IE cases. In conclusion PET/CT increases the diagnostic accuracy for IE in the subset of patients with possible IE and may help to manage a challenging situation.

Clinical value of FDG PET/CT in predicting local failure in patients with esophageal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15197-e15197
Author(s):  
Bingjie Fan ◽  
Man Hu ◽  
Li Kong ◽  
Xiaoli Zhang ◽  
Zheng Fu ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Local Recurrence ◽  
Fdg Pet ◽  
Residual Tumor ◽  
Local Failure ◽  
Fdg Uptake ◽  
Failure Patterns ◽  
Pet Ct ◽  
Fdg Pet Ct

e15197 Background: Local failure, including local residual tumor and local recurrence, is the most common failure patterns for patients with esophageal cancer (EC) treated with radiotherapy. The purpose of this study was to evaluate the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for predicting local failure in patients with EC. Methods: Twenty-two patients with biopsy-proven EC treated definitively with RT with or without chemotherapy were enrolled from June 2010 to August 2012. Dose of 60.4 - 70.2 Gy with 1.8 - 2.0Gy /fraction were delivered with three-dimensional conformal radiation therapy (CRT). All patients underwent FDG PET/CT scan prior to therapy. The patients were followed up every 3 months after treatment completion. Patients who developed local failure were confirmed with histological evidence or follow-up. Results: The follow up time was in the range of 5-30 months. Of 22 patients, 3 patients had local residual tumor, 2 patients experienced local recurrence. The mean SUVmax for patients with local failure was higher than that for patients without local failure (15.688±3.115 vs. 14.137± 4.397, p = 0.54). The local failure regions were mostly the regions with higher metabolic activity before radiotherapy. Conclusions: Patients with higher FDG-uptake may have higher risk to experienced local failure. The local failure regions were localized mostly in the higher FDG uptake regions of pre-therapeutically FGD PET/CT scans of the patients with EC.

Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Interpretation Criteria for Assessment of Antibiotic Treatment Response in Pyogenic Spine Infection

2015 ◽  
Vol 66 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Silvia A. Riccio ◽  
Angel K.M. Chu ◽  
Harvey R. Rabin ◽  
Reinhard Kloiber
Keyword(s):  
Soft Tissue ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Active Infection ◽  
Spine Infection ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

Purpose The objective of the study was to determine if fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) can assess the response of patients with pyogenic spine infection to antibiotic treatment in a clinically useful time frame. Methods Twenty-eight patients with suspected pyogenic spine infection had baseline 18F-FDG PET/CT. Patients with proven or probable infection were divided into good and poor responders to antibiotic therapy based on clinical criteria. These patients had a follow-up 18F-FDG PET/CT 6-8 weeks later. Results Six of 28 patients were deemed negative for infection based on 18F-FDG PET/CT. Two patients were excluded because of discrepancies in interpretation. Of the 20 patients deemed positive for infection, 13 had a pathogen isolated and all showed 18F-FDG uptake in bone and/or soft tissue at baseline. Patients with a poor clinical response to treatment had persistent 18F-FDG uptake in bone and/or soft tissue on follow-up. Patients with good clinical response had uptake confined to the margins of the destroyed disc. None of these patients had recurrent infection, even if antibiotics had already been discontinued at the time of the follow-up scan. Conclusions 18F-FDG uptake confined to the margins of a destroyed disc after antibiotic therapy of pyogenic spine infection must not be considered indicative of persistent infection and likely represents mechanically induced inflammation. 18F-FDG uptake in bone or soft tissue does indicate active infection. Quantification of activity could not reliably differentiate patients with active infection from those without active infection and those who had had a successful response to therapy. The pattern of activity is critical to accurate interpretation.

scholarly journals Clinical presentation and treatment response in patients with polymyalgia rheumatica and giant cell arteritis during a 40-week follow-up

2021 ◽  
Author(s):  
Amir Emamifar ◽  
Søren Hess ◽  
Torkell Ellingsen ◽  
Oke Gerke ◽  
Ziba Ahangarani Farahani ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Treatment Response ◽  
Giant Cell ◽  
Clinical Features ◽  
Polymyalgia Rheumatica ◽  
Fdg Pet ◽  
Temporal Artery Biopsy ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Objectives To study the clinical features of polymyalgia rheumatica and/or giant cell arteritis (PMR/GCA) and clinical predictors of treatment response during a 40-week follow-up period. Method Clinical data on 77 patients with newly diagnosed PMR/GCA who were treated by oral glucocorticoids were gathered at baseline and during 40-week follow-up period. A unilateral temporal artery biopsy (TAB) and 18 F-FDG PET/CT were undertaken at diagnosis. In total, each patient was seen at 5 occasions i.e. baseline, weeks 4, 16, 28, and 40. Treatment response was assessed considering clinical evaluations and results of inflammatory markers. Results Of 77 patients (49(63.6%) female, mean age : 71.8 ± 8.0), 64(83.1%) patients had pure PMR, 10(13.0%) concomitant PMR and GCA, and 3(3.9%) pure GCA. The patients reported clinical symptoms except scalp pain and duration of morning stiffness improved significantly at week 4 and remained lower at week 40 compared with the relative frequencies at baseline. Besides, all components of physical examination showed significant improvement and remained lower at week 40 compared with the baseline. 68.7%, 62.9%, 44.1% and 33.3% of the patients had a complete response at weeks 4, 16, 28, and 40, respectively. Several clinical features including female gender, younger age, fewer relapse, and lower level of baseline ESR were significantly associated with a better treatment response. Treatment response during follow-up period was independent of TAB results and FDG uptakes on 18 F-FDG PET/CT at diagnosis. Conclusion Obtaining valid disease specific outcome measures for evaluating treatment efficacy in PMR and GCA, that can be applied universally is clearly an unmet clinical need. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT02985424

18F-FDG PET-CT postoperative changes after maxillectomy: Findings and pitfalls in interpretation

2021 ◽  
pp. 20200574
Author(s):  
Tima Davidson ◽  
Johnatan Nissan ◽  
Maria Krichmar ◽  
Eyal Lotan ◽  
Shai Shrot ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Ct Scanning ◽  
Fdg Uptake ◽  
Postoperative Changes ◽  
Pet Ct ◽  
The Mean ◽  
Fdg Pet Ct ◽  
Mucosal Thickening ◽  
Ct Features

Objective: We investigated the findings and pitfalls of FDG-PET/CT scanning after maxillectomy with reconstruction/rehabilitation procedures, in patients with head and neck malignancies treated during nine years at one tertiary medical centre. Methods: Fourteen patients (10 males), aged 22–84 years, underwent 17 reconstruction/rehabilitation maxillectomy surgeries and 35 PET/CT scans. Postoperative PET/CT findings were correlated with clinical and imaging follow-up. Results: Increased FDG uptake, mean SUVmax 2.4 ± 1.4 (range 0.3–4.3), was observed at the postoperative bed following 12 of 17 surgeries (71%; 10 obturators, two mesh reconstructions). Following the remaining 5/17 surgeries (three with a fat flap and two without any reconstructions), abnormal FDG uptake was not observed at the postoperative bed. CT features of postoperative sites included: non-homogeneous mixed iso/hyperdense structures (hollow or filled) with multiple surrounding and/or inside air bubbles (“sponge appearance”) and mucosal thickening along the postoperative bed wall (in all cases with obturator implants); rich fat density material in reconstructions with a fat flap and in closures without reconstruction, and radiopaque elongated structures in mesh reconstructions. No correlation was found of the mean SUVmax in initial scans, with the time from the surgery date (10 ± 6 months; r=0.04, P=0.90), or with the mean SUVmax in final scans (at 25± 17 months, P=0.17). Conclusions: : Increased FDG uptake, together with corresponding non-specific CT features, may persist for a prolonged period after surgery with obturators and mesh implantations, mimicking malignancy or infection. Awareness of variations in postoperative PET-CT appearance can help avoid false interpretations and redundant invasive procedures.

scholarly journals The clinical impact of incidental sellar uptake on F-18 FDG PET/CT

2019 ◽  
Vol 6 (2) ◽  
pp. IJE15
Author(s):  
Zehra Pınar Koç ◽  
Pelin Özcan Kara ◽  
Emel Sezer ◽  
Kadir Eser ◽  
Anıl Özgür
Keyword(s):  
Fdg Pet ◽  
Standardized Uptake Value ◽  
Sellar Region ◽  
Primary Tumors ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Frequent Finding ◽  
Metastatic Involvement ◽  
Fdg Pet Ct

Aim: The most frequent finding associated with incidental fluorodeoxyglucose (FDG) uptake in sellar region in oncologic F-18 FDG PET/CT is adenoma. However, reports of metastatic involvement exist. We investigated the clinical significance of incidental FDG uptake in this region. Materials & method: 34 patients with several primary tumors who were referred for staging, restaging or treatment response via F-18 FDG PET/CT were included. Images were reviewed and patients with significant FDG uptake in the sellar region were referred. Results: Mean lesion diameter was 11.9 ± 4.9 mm and mean standardized uptake value was 8.2 ± 6.1. Thirteen patients underwent MRI, and the others underwent follow-up F-18 FDG PET/CT. MRI revealed metastatic involvement in nine patients and macro- or micro-adenoma in four. Metastatic patients also had other lesions, yet management did not change. Conclusion: FDG accumulation in the sellar region might be associated with metastasis or adenoma. However, it did not change management. Future studies are warranted.

Fusion of Metabolic Function and Morphology: Sequential [18F]Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography Studies Yield New Insights Into the Natural History of Bone Metastases in Breast Cancer

2007 ◽  
Vol 25 (23) ◽  
pp. 3440-3447 ◽  
Author(s):  
Yong Du ◽  
Ian Cullum ◽  
Tim M. Illidge ◽  
Peter J. Ell
Keyword(s):  
Bone Metastases ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Mixed Pattern ◽  
Fdg Pet Ct ◽  
Morphology Changes

Purpose By monitoring bone metastases with sequential [18F]fluorodeoxyglucose positron-emission tomography/computed tomography ([18F]FDG-PET/CT) imaging, this study investigates the clinical relevance of [18F]FDG uptake features of bone metastases with various radiographic appearances. Patients and Methods Bone metastases were found in 67 of 408 consecutive patients with known/suspected recurrent breast cancer on [18F]FDG-PET/CT, characterized by CT morphology changes and/or bony [18F]FDG uptake. Twenty-five of the patients had sequential [18F]FDG-PET/CT examinations (86 studies) over an average follow-up period of 23 months. The temporal changes in [18F]FDG uptake and corresponding CT morphology features of 146 bone lesions identified in these 25 patients were followed up and correlated with therapeutic outcome retrospectively. Results The 146 lesions were classified as osteolytic (77), osteoblastic (41), mixed-pattern (11), or no change/negative (17) on CT. The majority of the osteolytic (72; 93.5%) and mixed-pattern lesions (nine; 81.8%), but fewer of the osteoblastic lesions (25; 61%), showed increased [18F]FDG uptake. After treatment, 58 osteolytic lesions (80.5%) became [18F]FDG negative and osteoblastic on CT and only 14 relatively large lesions (19.5%) remained [18F]FDG avid. Of the 25 [18F]FDG-avid osteoblastic lesions, 13 (52%) became [18F]FDG negative, but 12 (48%) remained [18F]FDG avid and increased in size on CT. Five of the mixed-pattern lesions remained [18F]FDG avid after treatment. All 17 CT-negative lesions became [18F]FDG negative; however, nine of them became osteoblastic. None of the initially [18F]FDG-negative lesions showed [18F]FDG avidity during follow-up. Conclusion [18F]FDG uptake reflects the immediate tumor activity of bone metastases, whereas the radiographic morphology changes vary greatly with time among patients.

Role of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT) in malignant ovarian germ cell tumors: a single-center experience with long term follow-up

2019 ◽  
Vol 29 (8) ◽  
pp. 1298-1303
Author(s):  
Carlotta Dolci ◽  
Lorenzo Ceppi ◽  
Luca Guerra ◽  
Cinzia Crivellaro ◽  
Maria Lamanna ◽  
...  
Keyword(s):  
Germ Cell ◽  
Predictive Value ◽  
Fdg Pet ◽  
Germ Cell Tumors ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Staging Surgery ◽  
Fdg Pet Ct

Introduction18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a diagnostic tool widely used in oncology, but to date there are no established recommendations for its use in malignant ovarian germ cell tumors. The aim of this study was to evaluate the role of 18F-FDG PET/CT in the clinical management of patients with malignant ovarian germ cell tumors.MethodsThis was a retrospective review of 18F-FDG PET/CT scans performed in patients diagnosed with malignant ovarian germ cell tumors treated at the gynecology department of San Gerardo Hospital (Monza, Italy) from June 2006 to December 2016. Data collected included clinical history, radiological, biochemical and pathological evaluation, treatment, follow-up, outcome, and clinical indication for the PET/CT scan. PET/CT findings were categorized as negative/normal (no abnormal FDG uptake or physiological uptake), positive/abnormal (FDG uptake considered to indicate active germ cell malignancy), or equivocal (FDG uptake of uncertain significance, not clearly correlated to neoplastic disease).ResultsA total of 69 PET/CT scans in 37 patients were evaluated. The mean age at diagnosis was 25 years (range 20–48). The majority of patients had International Federation of Gynecology and Obstetrics (FIGO) stage I (22/37) disease and had a diagnosis of dysgerminomas (18/37). Imaging indications were initial staging before treatment (4/69, 6%), staging after inadequate staging surgery (24/69, 35%), restaging after adjuvant chemotherapy (17/69, 25%), relapse suspect (9/69, 13%), and follow-up (15/69, 21%). Pathology confirmation of PET/CT results was available in 28/69 (40.5%) studies. All negative PET/CT (15/28) cases were confirmed with laparoscopy as true negative; among 13/28 positive PET cases, histopathology confirmed 7 (54%) as true positive and 6 (46%) as false positive (5 inflammatory and 1 mature teratoma implants). Patient-based analysis showed 100% sensitivity, 71% specificity, 54% positive predictive value, 100% negative predictive value, and 79% accuracy. Clinical follow-up was available in 41 (59.4%) of 69 PET/CT images: 28/41 studies were negative and 13/41 positive. A mean follow-up of 28 months (median 15, range 5–102) confirmed negative PET/CT studies. A total of 13 positive PET/CT patients underwent chemotherapy with subsequent evidence of disease response.DiscussionPET/CT in malignant ovarian germ cell tumors was mainly performed for staging after inadequate staging surgery or for restaging after adjuvant chemotherapy. PET/CT was associated with high sensitivity and negative predictive value.

scholarly journals OP0190 USEFULNESS OF 18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY IN DIAGNOSING POLYMYALGIA RHEUMATICA AND LARGE-VESSEL VASCULITIS: A CASE-CONTROL STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 114.2-115
Author(s):  
A. Desvages ◽  
F. Hives ◽  
X. Deprez ◽  
A. Pierache ◽  
R. M. Flipo ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Polymyalgia Rheumatica ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Control Groups ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
And Control

Background:Polymyalgia rheumatica (PMR) is a relatively common disease among the elderly. None of the most common imaging techniques provides diagnostic certainty of PMR. 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) may be a useful candidate as it can be used to visualize articular and periarticular FDG uptake at different locations, as well as associated large-vessel vasculitis (LVV), but its usefulness needs to be evaluated in the absence of large-scale case-control studies.Objectives:The purpose of this study was to determine the usefulness of FDG-PET/CT in diagnosing PMR and LVV.Methods:We analysed FDG-PET/CT scans performed between January 2015 and December 2019 on patients diagnosed with PMR. For comparisons, patients with PMR were matched 1:1 to controls according to age and sex. FDG-PET/CT scans had been performed on controls over the same period for diagnosis of cancer-associated stroke. FDG uptake was scored visually using a semi-quantitative analysis (score 0-3) for 17 articular or periarticular sites, as described by Sondag et al. [1], and for 13 vascular sites, as described by Slart et al. [2]. The case and control groups were compared using generalized linear mixed models (binomial distribution, logit function) for binary outcomes, and linear mixed models for continuous outcomes, with matched sets as a random effect. The optimal threshold for the number of sites with significant hyperfixation (score ≥ 2) was determined by maximizing the Youden index.Results:81 patients with a diagnosis of PMR and 81 controls were included (mean (SD) age 70.7 (9.8) years; 44.4% women). We found significant differences between the PMR and control groups at all articular or periarticular sites for: 1) FDG uptake score (p<0.0001); 2) number of patients per site with significant FDG uptake (score ≥ 2) (p<0.0001); 3) global FDG articular uptake scores (score 0-51) (31 [IQR, 21 to 37] versus 6 [IQR, 3 to 10], p<0.001); and 4) number of sites with significant FDG uptake (score ≥ 2) (score 0-17) (11 [IQR, 7 to 13] versus 1 [IQR, 0 to 2], p<0.001). Using ROC curve analysis (Figure 1), we found that the presence of 6 or more sites with significant FDG uptake (≥ 2) was associated with the diagnosis of PMR with a sensitivity of 84% and a specificity of 96% (AUC 0.96 [95% CI 0.93-0.99]). No significant differences in global FDG vascular uptake scores (score 0-39) or in number of patients with at least 1 significant uptake vascular site (score ≥ 2) were found between the PMR and control groups (1 [IQR, 0 to 4] versus 4 [0 to 6], p=0.06 and 8 (11.3%) versus 10 (14.1%), p=0.62 respectively).Figure 1.ROC curve analyzing performance of FDG-PET/CT for the diagnosis of PMR according to the number of sites with significant FDG uptake (≥ 2)Conclusion:Our results demonstrate that the FDG uptake score and the number of sites with significant FDG uptake could be relevant criteria for the diagnosis of PMR. However, unlike other authors, we found no evidence suggesting that FDG-PET/CT may be useful in diagnosing silent underlying LVV in patients with isolated PMR.References:[1]Sondag M, Guillot X, Verhoeven F, Blagosklonov O, Prati C, Boulahdour H, et al. Utility of 18F-fluoro-dexoxyglucose positron emission tomography for the diagnosis of polymyalgia rheumatica: a controlled study. Rheumatology (Oxford). 2016;55(8):1452-7.[2]Slart RHJA, Writing group, Reviewer group, Members of EANM Cardiovascular, Members of EANM Infection & Inflammation, Members of Committees, SNMMI Cardiovascular, Members of Council, PET Interest Group, et al. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging. 2018;45(7):1250-69.Disclosure of Interests:None declared

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