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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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18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images at diagnosis and after steroid and tocilizumab treatment in a patient with adult-onset Still’s disease (AOSD). (A1, B1, and C1) Marked FDG accumulation was observed in the bone marrow, spleen, and multiple lymph nodes at diagnosis. (A2, B2, and C2) After treatment, FDG uptake decreased in these sites - bone marrow, from SUVmax = 4.02 (A1) to 2.50 (A2); spleen, from SUVmax = 6.05 (A1 and C1) to 4.38 (A2 and C2) - as well as in multiple lymph nodes, including in the axilla, mediastinum, hilar region of the lung, hilar region of the liver, and para-aortic region (B1/C1 → B2/C2). SUV, standardized uptake value.
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Fig4: 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images at diagnosis and after steroid and tocilizumab treatment in a patient with adult-onset Still’s disease (AOSD). (A1, B1, and C1) Marked FDG accumulation was observed in the bone marrow, spleen, and multiple lymph nodes at diagnosis. (A2, B2, and C2) After treatment, FDG uptake decreased in these sites - bone marrow, from SUVmax = 4.02 (A1) to 2.50 (A2); spleen, from SUVmax = 6.05 (A1 and C1) to 4.38 (A2 and C2) - as well as in multiple lymph nodes, including in the axilla, mediastinum, hilar region of the lung, hilar region of the liver, and para-aortic region (B1/C1 → B2/C2). SUV, standardized uptake value.

Mentions: Typical FDG-PET/CT images of adult-onset Still’s disease (AOSD) are shown in Figure 4 [38]. We first evaluated FDG-PET/CT for diagnosis and disease evaluation of AOSD by investigating FDG uptake for characteristic findings in seven patients with AOSD and reviewing the literature on seven previous reports of PET/CT in patients with AOSD [38]. FDG accumulation was positive mainly in the bone marrow (100%), spleen (90.9%), lymph nodes (80.0%), and joints (75.0%). In addition, FDG uptake was positive in the pericardium, pleura, salivary glands, eyelids, muscle, and major blood vessels. Follow-up PET/CT showed diminished FDG accumulation, as measured by SUVmax, in the bone marrow, spleen, and lymph nodes. The only correlation with laboratory data was between lactate dehydrogenase and spleen SUV. In conclusion, FDG-PET/CT is useful for long-term assessment of AOSD activity in individual patients. However, PET/CT findings alone are not sufficient to make a differential diagnosis of AOSD versus malignant lymphoma.Figure 4


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

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

18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images at diagnosis and after steroid and tocilizumab treatment in a patient with adult-onset Still’s disease (AOSD). (A1, B1, and C1) Marked FDG accumulation was observed in the bone marrow, spleen, and multiple lymph nodes at diagnosis. (A2, B2, and C2) After treatment, FDG uptake decreased in these sites - bone marrow, from SUVmax = 4.02 (A1) to 2.50 (A2); spleen, from SUVmax = 6.05 (A1 and C1) to 4.38 (A2 and C2) - as well as in multiple lymph nodes, including in the axilla, mediastinum, hilar region of the lung, hilar region of the liver, and para-aortic region (B1/C1 → B2/C2). SUV, standardized uptake value.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images at diagnosis and after steroid and tocilizumab treatment in a patient with adult-onset Still’s disease (AOSD). (A1, B1, and C1) Marked FDG accumulation was observed in the bone marrow, spleen, and multiple lymph nodes at diagnosis. (A2, B2, and C2) After treatment, FDG uptake decreased in these sites - bone marrow, from SUVmax = 4.02 (A1) to 2.50 (A2); spleen, from SUVmax = 6.05 (A1 and C1) to 4.38 (A2 and C2) - as well as in multiple lymph nodes, including in the axilla, mediastinum, hilar region of the lung, hilar region of the liver, and para-aortic region (B1/C1 → B2/C2). SUV, standardized uptake value.
Mentions: Typical FDG-PET/CT images of adult-onset Still’s disease (AOSD) are shown in Figure 4 [38]. We first evaluated FDG-PET/CT for diagnosis and disease evaluation of AOSD by investigating FDG uptake for characteristic findings in seven patients with AOSD and reviewing the literature on seven previous reports of PET/CT in patients with AOSD [38]. FDG accumulation was positive mainly in the bone marrow (100%), spleen (90.9%), lymph nodes (80.0%), and joints (75.0%). In addition, FDG uptake was positive in the pericardium, pleura, salivary glands, eyelids, muscle, and major blood vessels. Follow-up PET/CT showed diminished FDG accumulation, as measured by SUVmax, in the bone marrow, spleen, and lymph nodes. The only correlation with laboratory data was between lactate dehydrogenase and spleen SUV. In conclusion, FDG-PET/CT is useful for long-term assessment of AOSD activity in individual patients. However, PET/CT findings alone are not sufficient to make a differential diagnosis of AOSD versus malignant lymphoma.Figure 4

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