Whole-Body [<sup>18</sup>F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease
The 2-deoxy-d-[<sup>18</sup>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 [<...
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2021
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oai:doaj.org-article:b1962eacd28e46de946478204ed6988a2021-11-25T17:21:24ZWhole-Body [<sup>18</sup>F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease10.3390/diagnostics111120732075-4418https://doaj.org/article/b1962eacd28e46de946478204ed6988a2021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4418/11/11/2073https://doaj.org/toc/2075-4418The 2-deoxy-d-[<sup>18</sup>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 [<sup>18</sup>F]FDG PET/CT on change in initially suspected diagnosis in patients at the time of the scan. Thirty-four patients, who had undergone [<sup>18</sup>F]FDG PET/CT, were enrolled and the initially suspected diagnosis prior to [<sup>18</sup>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 [<sup>18</sup>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 [<sup>18</sup>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, [<sup>18</sup>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), <i>p</i> = 0.07), but not when compared to PMR + GCA (1.04 ± 0.14 (95%CI, 0.95–1.13), <i>p</i> = 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); <i>p</i> < 0.0001, respectively). In individuals with a suspected diagnosis of rheumatic disease, an inflammatory-directed [<sup>18</sup>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.Matthias FröhlichSebastian SerflingTakahiro HiguchiMartin G. PomperSteven P. RoweMarc SchmalzingHans-Peter TonyMichael GernertPatrick-Pascal StrunzJan PortegysEva-Christina SchwaneckOttar GadeholtAlexander WeichAndreas K. BuckThorsten A. BleyKonstanze V. GuggenbergerRudolf A. WernerMDPI AGarticlegiant cell arteritisGCA[<sup>18</sup>F]FDG PET/CTvasculatureinflammationpolymyalgia rheumaticaMedicine (General)R5-920ENDiagnostics, Vol 11, Iss 2073, p 2073 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
giant cell arteritis GCA [<sup>18</sup>F]FDG PET/CT vasculature inflammation polymyalgia rheumatica Medicine (General) R5-920 |
| spellingShingle |
giant cell arteritis GCA [<sup>18</sup>F]FDG PET/CT vasculature inflammation polymyalgia rheumatica Medicine (General) R5-920 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 Whole-Body [<sup>18</sup>F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease |
| description |
The 2-deoxy-d-[<sup>18</sup>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 [<sup>18</sup>F]FDG PET/CT on change in initially suspected diagnosis in patients at the time of the scan. Thirty-four patients, who had undergone [<sup>18</sup>F]FDG PET/CT, were enrolled and the initially suspected diagnosis prior to [<sup>18</sup>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 [<sup>18</sup>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 [<sup>18</sup>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, [<sup>18</sup>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), <i>p</i> = 0.07), but not when compared to PMR + GCA (1.04 ± 0.14 (95%CI, 0.95–1.13), <i>p</i> = 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); <i>p</i> < 0.0001, respectively). In individuals with a suspected diagnosis of rheumatic disease, an inflammatory-directed [<sup>18</sup>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. |
| format |
article |
| author |
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 |
| author_facet |
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 |
| author_sort |
Matthias Fröhlich |
| title |
Whole-Body [<sup>18</sup>F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease |
| title_short |
Whole-Body [<sup>18</sup>F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease |
| title_full |
Whole-Body [<sup>18</sup>F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease |
| title_fullStr |
Whole-Body [<sup>18</sup>F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease |
| title_full_unstemmed |
Whole-Body [<sup>18</sup>F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease |
| title_sort |
whole-body [<sup>18</sup>f]fdg pet/ct can alter diagnosis in patients with suspected rheumatic disease |
| publisher |
MDPI AG |
| publishDate |
2021 |
| url |
https://doaj.org/article/b1962eacd28e46de946478204ed6988a |
| work_keys_str_mv |
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