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.
N1 - Funding Information:
Funding: This work was supported by the German Research Council (DFG grant HI 1789/3-3) and through the Okayama University “RECTOR” Program (TH). The project has also received support from the Competence Network of Heart Failure, funded by the Integrated Research and Treatment Center (IFB) of the Federal Ministry of Education and Research (BmBF) of Germany. A KAKENHI grant (JP15K21774) was provided for Dr. T. Higuchi from the Japan Society for the Promotion of Science (JSPS). This publication was supported by the Open Access Publication Fund of the University of Wuerzburg.
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
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.
KW - GCA
KW - Giant cell arteritis
KW - Inflammation
KW - PMR
KW - Polymyalgia rheumatica
KW - Vasculature
KW - Vasculitis
KW - [ F]FDG PET/CT
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U2 - 10.3390/diagnostics11112073
DO - 10.3390/diagnostics11112073
M3 - Article
C2 - 34829421
AN - SCOPUS:85119607296
SN - 2075-4418
VL - 11
JO - Diagnostics
JF - Diagnostics
IS - 11
M1 - 2073
ER -