Whole-body [18 f]fdg pet/ct can alter diagnosis in patients with suspected rheumatic disease

Matthias Fröhlich; Sebastian Serfling; Takahiro Higuchi; Martin G. Pomper; Steven P. Rowe; Marc Schmalzing; Hans Peter Tony; Michael Gernert; Patrick Pascal Strunz; Jan Portegys; Eva Christina Schwaneck; Ottar Gadeholt; Alexander Weich; Andreas K. Buck; Thorsten A. Bley; Konstanze V. Guggenberger; Rudolf A. Werner

doi:10.3390/diagnostics11112073

Whole-body [¹⁸ f]fdg pet/ct can alter diagnosis in patients with suspected rheumatic disease

Matthias Fröhlich, Sebastian Serfling, Takahiro Higuchi, Martin G. Pomper, Steven P. Rowe, Marc Schmalzing, Hans Peter Tony, Michael Gernert, Patrick Pascal Strunz, Jan Portegys, Eva Christina Schwaneck, Ottar Gadeholt, Alexander Weich, Andreas K. Buck, Thorsten A. Bley, Konstanze V. Guggenberger, Rudolf A. Werner

Research output: Contribution to journal › Article › peer-review

Abstract

The 2-deoxy-d-[¹⁸ F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely utilized to assess the vascular and articular inflammatory burden of patients with a suspected diagnosis of rheumatic disease. We aimed to elucidate the impact of [¹⁸ F]FDG PET/CT on change in initially suspected diagnosis in patients at the time of the scan. Thirty-four patients, who had undergone [¹⁸ F]FDG PET/CT, were enrolled and the initially suspected diagnosis prior to [¹⁸ F]FDG PET/CT was compared to the final diagnosis. In addition, a semi-quantitative analysis including vessel wall-to-liver (VLR) and joint-to-liver (JLR) ratios was also conducted. Prior to [¹⁸ F]FDG PET/CT, 22/34 (64.7%) of patients did not have an established diagnosis, whereas in 7/34 (20.6%), polymyalgia rheumatica (PMR) was suspected, and in 5/34 (14.7%), giant cell arteritis (GCA) was suspected by the referring rheumatologists. After [¹⁸ F]FDG PET/CT, the diagnosis was GCA in 19/34 (55.9%), combined GCA and PMR (GCA + PMR) in 9/34 (26.5%) and PMR in the remaining 6/34 (17.6%). As such, [¹⁸ F]FDG PET/CT altered suspected diagnosis in 28/34 (82.4%), including in all unclear cases. VLR of patients whose final diagnosis was GCA tended to be significantly higher when compared to VLR in PMR (GCA, 1.01 ± 0.08 (95%CI, 0.95–1.1) vs. PMR, 0.92 ± 0.1 (95%CI, 0.85–0.99), p = 0.07), but not when compared to PMR + GCA (1.04 ± 0.14 (95%CI, 0.95–1.13), p = 1). JLR of individuals finally diagnosed with PMR (0.94 ± 0.16, (95%CI, 0.83–1.06)), however, was significantly increased relative to JLR in GCA (0.58 ± 0.04 (95%CI, 0.55–0.61)) and GCA + PMR (0.64 ± 0.09 (95%CI, 0.57–0.71); p < 0.0001, respec-tively). In individuals with a suspected diagnosis of rheumatic disease, an inflammatory-directed [¹⁸ F]FDG PET/CT can alter diagnosis in the majority of the cases, particularly in subjects who were referred because of diagnostic uncertainty. Semi-quantitative assessment may be helpful in establishing a final diagnosis of PMR, supporting the notion that a quantitative whole-body read-out may be useful in unclear cases.

Original language	English (US)
Article number	2073
Journal	Diagnostics
Volume	11
Issue number	11
DOIs	https://doi.org/10.3390/diagnostics11112073
State	Published - Nov 2021
Externally published	Yes

Keywords

GCA
Giant cell arteritis
Inflammation
PMR
Polymyalgia rheumatica
Vasculature
Vasculitis
[ F]FDG PET/CT

ASJC Scopus subject areas

Clinical Biochemistry

Access to Document

10.3390/diagnostics11112073

Cite this

Fröhlich, M., Serfling, S., Higuchi, T., Pomper, M. G., Rowe, S. P., Schmalzing, M., Tony, H. P., Gernert, M., Strunz, P. P., Portegys, J., Schwaneck, E. C., Gadeholt, O., Weich, A., Buck, A. K., Bley, T. A., Guggenberger, K. V., & Werner, R. A. (2021). Whole-body [¹⁸ f]fdg pet/ct can alter diagnosis in patients with suspected rheumatic disease. Diagnostics, 11(11), Article 2073. https://doi.org/10.3390/diagnostics11112073

Fröhlich, M, Serfling, S, Higuchi, T, Pomper, MG, Rowe, SP, Schmalzing, M, Tony, HP, Gernert, M, Strunz, PP, Portegys, J, Schwaneck, EC, Gadeholt, O, Weich, A, Buck, AK, Bley, TA, Guggenberger, KV & Werner, RA 2021, 'Whole-body [¹⁸ f]fdg pet/ct can alter diagnosis in patients with suspected rheumatic disease', Diagnostics, vol. 11, no. 11, 2073. https://doi.org/10.3390/diagnostics11112073

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title = "Whole-body [18 f]fdg pet/ct can alter diagnosis in patients with suspected rheumatic disease",

abstract = "The 2-deoxy-d-[18 F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely utilized to assess the vascular and articular inflammatory burden of patients with a suspected diagnosis of rheumatic disease. We aimed to elucidate the impact of [18 F]FDG PET/CT on change in initially suspected diagnosis in patients at the time of the scan. Thirty-four patients, who had undergone [18 F]FDG PET/CT, were enrolled and the initially suspected diagnosis prior to [18 F]FDG PET/CT was compared to the final diagnosis. In addition, a semi-quantitative analysis including vessel wall-to-liver (VLR) and joint-to-liver (JLR) ratios was also conducted. Prior to [18 F]FDG PET/CT, 22/34 (64.7%) of patients did not have an established diagnosis, whereas in 7/34 (20.6%), polymyalgia rheumatica (PMR) was suspected, and in 5/34 (14.7%), giant cell arteritis (GCA) was suspected by the referring rheumatologists. After [18 F]FDG PET/CT, the diagnosis was GCA in 19/34 (55.9%), combined GCA and PMR (GCA + PMR) in 9/34 (26.5%) and PMR in the remaining 6/34 (17.6%). As such, [18 F]FDG PET/CT altered suspected diagnosis in 28/34 (82.4%), including in all unclear cases. VLR of patients whose final diagnosis was GCA tended to be significantly higher when compared to VLR in PMR (GCA, 1.01 ± 0.08 (95%CI, 0.95–1.1) vs. PMR, 0.92 ± 0.1 (95%CI, 0.85–0.99), p = 0.07), but not when compared to PMR + GCA (1.04 ± 0.14 (95%CI, 0.95–1.13), p = 1). JLR of individuals finally diagnosed with PMR (0.94 ± 0.16, (95%CI, 0.83–1.06)), however, was significantly increased relative to JLR in GCA (0.58 ± 0.04 (95%CI, 0.55–0.61)) and GCA + PMR (0.64 ± 0.09 (95%CI, 0.57–0.71); p < 0.0001, respec-tively). In individuals with a suspected diagnosis of rheumatic disease, an inflammatory-directed [18 F]FDG PET/CT can alter diagnosis in the majority of the cases, particularly in subjects who were referred because of diagnostic uncertainty. Semi-quantitative assessment may be helpful in establishing a final diagnosis of PMR, supporting the notion that a quantitative whole-body read-out may be useful in unclear cases.",

keywords = "GCA, Giant cell arteritis, Inflammation, PMR, Polymyalgia rheumatica, Vasculature, Vasculitis, [ F]FDG PET/CT",

author = "Matthias Fr{\"o}hlich and Sebastian Serfling and Takahiro Higuchi and Pomper, {Martin G.} and Rowe, {Steven P.} and Marc Schmalzing and Tony, {Hans Peter} and Michael Gernert and Strunz, {Patrick Pascal} and Jan Portegys and Schwaneck, {Eva Christina} and Ottar Gadeholt and Alexander Weich and Buck, {Andreas K.} and Bley, {Thorsten A.} and Guggenberger, {Konstanze V.} and Werner, {Rudolf A.}",

note = "Publisher Copyright: {\textcopyright} 2021 by the authors. Licensee MDPI, Basel, Switzerland.",

year = "2021",

month = nov,

doi = "10.3390/diagnostics11112073",

language = "English (US)",

volume = "11",

journal = "Diagnostics",

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TY - JOUR

T1 - Whole-body [18 f]fdg pet/ct can alter diagnosis in patients with suspected rheumatic disease

AU - Fröhlich, Matthias

AU - Serfling, Sebastian

AU - Higuchi, Takahiro

AU - Pomper, Martin G.

AU - Rowe, Steven P.

AU - Schmalzing, Marc

AU - Tony, Hans Peter

AU - Gernert, Michael

AU - Strunz, Patrick Pascal

AU - Portegys, Jan

AU - Schwaneck, Eva Christina

AU - Gadeholt, Ottar

AU - Weich, Alexander

AU - Buck, Andreas K.

AU - Bley, Thorsten A.

AU - Guggenberger, Konstanze V.

AU - Werner, Rudolf A.

PY - 2021/11

Y1 - 2021/11

N2 - The 2-deoxy-d-[18 F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely utilized to assess the vascular and articular inflammatory burden of patients with a suspected diagnosis of rheumatic disease. We aimed to elucidate the impact of [18 F]FDG PET/CT on change in initially suspected diagnosis in patients at the time of the scan. Thirty-four patients, who had undergone [18 F]FDG PET/CT, were enrolled and the initially suspected diagnosis prior to [18 F]FDG PET/CT was compared to the final diagnosis. In addition, a semi-quantitative analysis including vessel wall-to-liver (VLR) and joint-to-liver (JLR) ratios was also conducted. Prior to [18 F]FDG PET/CT, 22/34 (64.7%) of patients did not have an established diagnosis, whereas in 7/34 (20.6%), polymyalgia rheumatica (PMR) was suspected, and in 5/34 (14.7%), giant cell arteritis (GCA) was suspected by the referring rheumatologists. After [18 F]FDG PET/CT, the diagnosis was GCA in 19/34 (55.9%), combined GCA and PMR (GCA + PMR) in 9/34 (26.5%) and PMR in the remaining 6/34 (17.6%). As such, [18 F]FDG PET/CT altered suspected diagnosis in 28/34 (82.4%), including in all unclear cases. VLR of patients whose final diagnosis was GCA tended to be significantly higher when compared to VLR in PMR (GCA, 1.01 ± 0.08 (95%CI, 0.95–1.1) vs. PMR, 0.92 ± 0.1 (95%CI, 0.85–0.99), p = 0.07), but not when compared to PMR + GCA (1.04 ± 0.14 (95%CI, 0.95–1.13), p = 1). JLR of individuals finally diagnosed with PMR (0.94 ± 0.16, (95%CI, 0.83–1.06)), however, was significantly increased relative to JLR in GCA (0.58 ± 0.04 (95%CI, 0.55–0.61)) and GCA + PMR (0.64 ± 0.09 (95%CI, 0.57–0.71); p < 0.0001, respec-tively). In individuals with a suspected diagnosis of rheumatic disease, an inflammatory-directed [18 F]FDG PET/CT can alter diagnosis in the majority of the cases, particularly in subjects who were referred because of diagnostic uncertainty. Semi-quantitative assessment may be helpful in establishing a final diagnosis of PMR, supporting the notion that a quantitative whole-body read-out may be useful in unclear cases.

AB - The 2-deoxy-d-[18 F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely utilized to assess the vascular and articular inflammatory burden of patients with a suspected diagnosis of rheumatic disease. We aimed to elucidate the impact of [18 F]FDG PET/CT on change in initially suspected diagnosis in patients at the time of the scan. Thirty-four patients, who had undergone [18 F]FDG PET/CT, were enrolled and the initially suspected diagnosis prior to [18 F]FDG PET/CT was compared to the final diagnosis. In addition, a semi-quantitative analysis including vessel wall-to-liver (VLR) and joint-to-liver (JLR) ratios was also conducted. Prior to [18 F]FDG PET/CT, 22/34 (64.7%) of patients did not have an established diagnosis, whereas in 7/34 (20.6%), polymyalgia rheumatica (PMR) was suspected, and in 5/34 (14.7%), giant cell arteritis (GCA) was suspected by the referring rheumatologists. After [18 F]FDG PET/CT, the diagnosis was GCA in 19/34 (55.9%), combined GCA and PMR (GCA + PMR) in 9/34 (26.5%) and PMR in the remaining 6/34 (17.6%). As such, [18 F]FDG PET/CT altered suspected diagnosis in 28/34 (82.4%), including in all unclear cases. VLR of patients whose final diagnosis was GCA tended to be significantly higher when compared to VLR in PMR (GCA, 1.01 ± 0.08 (95%CI, 0.95–1.1) vs. PMR, 0.92 ± 0.1 (95%CI, 0.85–0.99), p = 0.07), but not when compared to PMR + GCA (1.04 ± 0.14 (95%CI, 0.95–1.13), p = 1). JLR of individuals finally diagnosed with PMR (0.94 ± 0.16, (95%CI, 0.83–1.06)), however, was significantly increased relative to JLR in GCA (0.58 ± 0.04 (95%CI, 0.55–0.61)) and GCA + PMR (0.64 ± 0.09 (95%CI, 0.57–0.71); p < 0.0001, respec-tively). In individuals with a suspected diagnosis of rheumatic disease, an inflammatory-directed [18 F]FDG PET/CT can alter diagnosis in the majority of the cases, particularly in subjects who were referred because of diagnostic uncertainty. Semi-quantitative assessment may be helpful in establishing a final diagnosis of PMR, supporting the notion that a quantitative whole-body read-out may be useful in unclear cases.

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KW - Giant cell arteritis

KW - Inflammation

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KW - Polymyalgia rheumatica

KW - Vasculature

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KW - [ F]FDG PET/CT

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