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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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Comparison of pre- and post-treatment18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images in a patient with relapsing polychondritis (RPC). (A) Maximum intensity projection and (B-D) axial FDG-PET/CT findings of RPC in a 74-year-old female patient presenting with nasal symptoms. The patient was positive for type II anti-collagen antibody, and nasal cartilage biopsy was consistent with RPC. FDG accumulation (SUVmax = 13.03) is well defined from the infrahilar region of the left inferior lobe to the pulmonary hilus (A1 and B1, arrow) and conspicuous in the nasal cavity (SUVmax = 9.50) (C1 and D1, arrow). Neither bronchial wall thickening nor bronchial stricture is apparent. Post-treatment images show a complete lack of accumulation (A2-D2). SUV, standardized uptake value.
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Fig5: Comparison of pre- and post-treatment18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images in a patient with relapsing polychondritis (RPC). (A) Maximum intensity projection and (B-D) axial FDG-PET/CT findings of RPC in a 74-year-old female patient presenting with nasal symptoms. The patient was positive for type II anti-collagen antibody, and nasal cartilage biopsy was consistent with RPC. FDG accumulation (SUVmax = 13.03) is well defined from the infrahilar region of the left inferior lobe to the pulmonary hilus (A1 and B1, arrow) and conspicuous in the nasal cavity (SUVmax = 9.50) (C1 and D1, arrow). Neither bronchial wall thickening nor bronchial stricture is apparent. Post-treatment images show a complete lack of accumulation (A2-D2). SUV, standardized uptake value.

Mentions: Typical FDG PET/CT images of relapsing polychondritis (RPC) are shown in Figure 5 [39]. RPC is relatively rare, and early diagnosis is difficult. We first investigated the utility of FDG-PET/CT for the diagnosis and evaluation of disease activity in five RPC patients undergoing FDG-PET/CT in our hospital and eight cases in the literature [39]. Typical FDG accumulation was noted in tracheobronchial trees, costal cartilage, joints, larynx, nasal cavity/paranasal sinuses, auricles, lymph nodes, and the aorta. In one patient, PET revealed nasal chondritis despite an absence of nasal changes upon physical examination. Of five patients with costochondritis, four remained asymptomatic. Of nine patients with airway FDG accumulation, eight developed respiratory symptoms and all had CT abnormalities. In the remaining patient, airway FDG accumulation was evident despite the absence of airway symptoms and a lack of abnormalities in the respiratory function test or CT. PET also revealed bronchial chondritis in asymptomatic patients. In the five patients examined by PET post-treatment, FDG accumulation diminished as symptoms improved and inflammation decreased. We conclude that FDG-PET/CT is a potentially powerful tool for the early diagnosis of RPC, especially in patients with affected organs that are difficult to biopsy. This modality also facilitates the evaluation of extent of disease and disease activity during treatment.Figure 5


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

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

Comparison of pre- and post-treatment18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images in a patient with relapsing polychondritis (RPC). (A) Maximum intensity projection and (B-D) axial FDG-PET/CT findings of RPC in a 74-year-old female patient presenting with nasal symptoms. The patient was positive for type II anti-collagen antibody, and nasal cartilage biopsy was consistent with RPC. FDG accumulation (SUVmax = 13.03) is well defined from the infrahilar region of the left inferior lobe to the pulmonary hilus (A1 and B1, arrow) and conspicuous in the nasal cavity (SUVmax = 9.50) (C1 and D1, arrow). Neither bronchial wall thickening nor bronchial stricture is apparent. Post-treatment images show a complete lack of accumulation (A2-D2). 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

Fig5: Comparison of pre- and post-treatment18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images in a patient with relapsing polychondritis (RPC). (A) Maximum intensity projection and (B-D) axial FDG-PET/CT findings of RPC in a 74-year-old female patient presenting with nasal symptoms. The patient was positive for type II anti-collagen antibody, and nasal cartilage biopsy was consistent with RPC. FDG accumulation (SUVmax = 13.03) is well defined from the infrahilar region of the left inferior lobe to the pulmonary hilus (A1 and B1, arrow) and conspicuous in the nasal cavity (SUVmax = 9.50) (C1 and D1, arrow). Neither bronchial wall thickening nor bronchial stricture is apparent. Post-treatment images show a complete lack of accumulation (A2-D2). SUV, standardized uptake value.
Mentions: Typical FDG PET/CT images of relapsing polychondritis (RPC) are shown in Figure 5 [39]. RPC is relatively rare, and early diagnosis is difficult. We first investigated the utility of FDG-PET/CT for the diagnosis and evaluation of disease activity in five RPC patients undergoing FDG-PET/CT in our hospital and eight cases in the literature [39]. Typical FDG accumulation was noted in tracheobronchial trees, costal cartilage, joints, larynx, nasal cavity/paranasal sinuses, auricles, lymph nodes, and the aorta. In one patient, PET revealed nasal chondritis despite an absence of nasal changes upon physical examination. Of five patients with costochondritis, four remained asymptomatic. Of nine patients with airway FDG accumulation, eight developed respiratory symptoms and all had CT abnormalities. In the remaining patient, airway FDG accumulation was evident despite the absence of airway symptoms and a lack of abnormalities in the respiratory function test or CT. PET also revealed bronchial chondritis in asymptomatic patients. In the five patients examined by PET post-treatment, FDG accumulation diminished as symptoms improved and inflammation decreased. We conclude that FDG-PET/CT is a potentially powerful tool for the early diagnosis of RPC, especially in patients with affected organs that are difficult to biopsy. This modality also facilitates the evaluation of extent of disease and disease activity during treatment.Figure 5

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