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Clinical value of whole-body PET/CT in patients with active rheumatic diseases.

Yamashita H, Kubota K, Mimori A - Arthritis Res. Ther. (2014)

Bottom Line: Positron emission tomography (PET) provides highly sensitive, quantitative imaging at a molecular level, revealing the important pathophysiological processes underlying inflammation.This review provides an overview of the current utility of 18 F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in patients with active rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, polymyalgia rheumatica, adult-onset Still's disease, relapsing polychondritis, immunoglobulin G4-related disease, large-vessel vasculitis, Wegener's granulomatosis, polymyositis, and dermatomyositis.We also discuss the role of FDG-PET/CT in the diagnosis and monitoring of these diseases.

View Article: PubMed Central - PubMed

Affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1, Toyama Shinjuku-ku, Tokyo 162-8655, Japan. hiroyuki_yjp2005@yahoo.co.jp

ABSTRACT
Advanced imaging techniques may enable early diagnosis and monitoring of therapy in various rheumatic diseases. To prevent irreversible tissue damage, inflammatory rheumatic disease must be diagnosed and treated in pre-clinical stages, requiring highly sensitive detection techniques. Positron emission tomography (PET) provides highly sensitive, quantitative imaging at a molecular level, revealing the important pathophysiological processes underlying inflammation. This review provides an overview of the current utility of 18 F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in patients with active rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, polymyalgia rheumatica, adult-onset Still's disease, relapsing polychondritis, immunoglobulin G4-related disease, large-vessel vasculitis, Wegener's granulomatosis, polymyositis, and dermatomyositis. We also discuss the role of FDG-PET/CT in the diagnosis and monitoring of these diseases.

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Typical18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) findings in a patient with rheumatoid arthritis (RA). (A) Maximum intensity projection and (B, C) axial FDG-PET/CT findings of RA in an 86-year-old woman presenting with polyarthritis. She was diagnosed with RA based on the presence of symmetrical polyarthritis that continued for more than 19 weeks with a severe inflammatory reaction (C-reactive protein, 12.72 mg/dL) and magnetic resonance imaging findings that showed synovitis and tendinitis. FDG-PET/CT showed (A) symmetrical arthritis and remarkable circular FDG uptake due to synovitis around the (B) shoulders and (C) hips.
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Fig1: Typical18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) findings in a patient with rheumatoid arthritis (RA). (A) Maximum intensity projection and (B, C) axial FDG-PET/CT findings of RA in an 86-year-old woman presenting with polyarthritis. She was diagnosed with RA based on the presence of symmetrical polyarthritis that continued for more than 19 weeks with a severe inflammatory reaction (C-reactive protein, 12.72 mg/dL) and magnetic resonance imaging findings that showed synovitis and tendinitis. FDG-PET/CT showed (A) symmetrical arthritis and remarkable circular FDG uptake due to synovitis around the (B) shoulders and (C) hips.

Mentions: Typical FDG-PET/CT images of rheumatoid arthritis (RA) are shown in Figure 1. In 1995, the first FDG-PET studies in patients with active RA revealed increased FDG uptake in clinically inflamed wrist joints. Furthermore, standardized uptake values (SUVs) for FDG were correlated with clinical indicators such as tenderness and swelling [10]; these findings were confirmed in other studies [11,12]. FDG SUV data in arthritis are also correlated with disease activity score 28 (DAS28) and simple disease activity index values. The number of FDG-positive joints is also strongly correlated with their cumulative SUV and disease duration [11]. However, Goerres and colleagues [13] found that simple visual semi-quantitative scoring (from 0 to 4) based on FDG joint uptake [12] also reflected clinical evidence of inflammation in joints. This approach eliminates the need to quantify tracer uptake but lacks objectivity. On the other hand, the semi-quantitative analysis using SUVs has better objectivity. Okamura and colleagues [14] found that the SUVs for 12 joints correlated with tender joint count (TJC) and that the SUVs for eight joints correlated with DAS28, DAS28-C-reactive protein (CRP), and TJC in patients with RA, suggesting a close relationship between SUVs for large joints and disease activity.Figure 1


Clinical value of whole-body PET/CT in patients with active rheumatic diseases.

Yamashita H, Kubota K, Mimori A - Arthritis Res. Ther. (2014)

Typical18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) findings in a patient with rheumatoid arthritis (RA). (A) Maximum intensity projection and (B, C) axial FDG-PET/CT findings of RA in an 86-year-old woman presenting with polyarthritis. She was diagnosed with RA based on the presence of symmetrical polyarthritis that continued for more than 19 weeks with a severe inflammatory reaction (C-reactive protein, 12.72 mg/dL) and magnetic resonance imaging findings that showed synovitis and tendinitis. FDG-PET/CT showed (A) symmetrical arthritis and remarkable circular FDG uptake due to synovitis around the (B) shoulders and (C) hips.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4289312&req=5

Fig1: Typical18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) findings in a patient with rheumatoid arthritis (RA). (A) Maximum intensity projection and (B, C) axial FDG-PET/CT findings of RA in an 86-year-old woman presenting with polyarthritis. She was diagnosed with RA based on the presence of symmetrical polyarthritis that continued for more than 19 weeks with a severe inflammatory reaction (C-reactive protein, 12.72 mg/dL) and magnetic resonance imaging findings that showed synovitis and tendinitis. FDG-PET/CT showed (A) symmetrical arthritis and remarkable circular FDG uptake due to synovitis around the (B) shoulders and (C) hips.
Mentions: Typical FDG-PET/CT images of rheumatoid arthritis (RA) are shown in Figure 1. In 1995, the first FDG-PET studies in patients with active RA revealed increased FDG uptake in clinically inflamed wrist joints. Furthermore, standardized uptake values (SUVs) for FDG were correlated with clinical indicators such as tenderness and swelling [10]; these findings were confirmed in other studies [11,12]. FDG SUV data in arthritis are also correlated with disease activity score 28 (DAS28) and simple disease activity index values. The number of FDG-positive joints is also strongly correlated with their cumulative SUV and disease duration [11]. However, Goerres and colleagues [13] found that simple visual semi-quantitative scoring (from 0 to 4) based on FDG joint uptake [12] also reflected clinical evidence of inflammation in joints. This approach eliminates the need to quantify tracer uptake but lacks objectivity. On the other hand, the semi-quantitative analysis using SUVs has better objectivity. Okamura and colleagues [14] found that the SUVs for 12 joints correlated with tender joint count (TJC) and that the SUVs for eight joints correlated with DAS28, DAS28-C-reactive protein (CRP), and TJC in patients with RA, suggesting a close relationship between SUVs for large joints and disease activity.Figure 1

Bottom Line: Positron emission tomography (PET) provides highly sensitive, quantitative imaging at a molecular level, revealing the important pathophysiological processes underlying inflammation.This review provides an overview of the current utility of 18 F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in patients with active rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, polymyalgia rheumatica, adult-onset Still's disease, relapsing polychondritis, immunoglobulin G4-related disease, large-vessel vasculitis, Wegener's granulomatosis, polymyositis, and dermatomyositis.We also discuss the role of FDG-PET/CT in the diagnosis and monitoring of these diseases.

View Article: PubMed Central - PubMed

Affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1, Toyama Shinjuku-ku, Tokyo 162-8655, Japan. hiroyuki_yjp2005@yahoo.co.jp

ABSTRACT
Advanced imaging techniques may enable early diagnosis and monitoring of therapy in various rheumatic diseases. To prevent irreversible tissue damage, inflammatory rheumatic disease must be diagnosed and treated in pre-clinical stages, requiring highly sensitive detection techniques. Positron emission tomography (PET) provides highly sensitive, quantitative imaging at a molecular level, revealing the important pathophysiological processes underlying inflammation. This review provides an overview of the current utility of 18 F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in patients with active rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, polymyalgia rheumatica, adult-onset Still's disease, relapsing polychondritis, immunoglobulin G4-related disease, large-vessel vasculitis, Wegener's granulomatosis, polymyositis, and dermatomyositis. We also discuss the role of FDG-PET/CT in the diagnosis and monitoring of these diseases.

Show MeSH
Related in: MedlinePlus