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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (5): 853-859. doi: 10.19723/j.issn.1671-167X.2024.05.016

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Application of 18F-FDG PET/CT in rheumatic diseases

Hua ZHONG1, Yuan LI2, Liling XU1, Mingxin BAI1, Yin SU1,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University People's Hospital; Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Beijing 100044, China
    2. Department of Nuclear Medicine, Peking University People's Hospital, Beijing 100044, China
  • Received:2021-07-28 Online:2024-10-18 Published:2024-10-16
  • Contact: Yin SU E-mail:suyin0921@163.com
  • Supported by:
    the Beijing Scientific Program(Z191100006619111)

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Abstract:

Objective: To explore the application of 18F-flurodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in rheumatic diseases, to compare these different imaging features, and to describe the current PET/CT imaging status in clinical practice. Methods: A total of 486 cases in our department from January 2012 to December 2018 were enrolled in this study, and 18F-FDG PET/CT examination was performed in all the patients. The clinical use of 18F-FDG PET/CT was retrospectively analyzed to discuss the clinical application and its imaging characteristics of rheumatic diseases. Categorical data were used to ascertain prevalence statistics, whereas continuous data were used to delineate means and standard deviations. Independent sample t test, Chi square test and Mann-Whitney U test were used for statistical analysis. A P-value of < 0.05 was considered significant. Results: (1) From 2012 to 2018, totally 486 patients in the Department of Rheumatology and Immunology underwent 18F-FDG PET/CT examination, accounting for 5.30% of the total number of PET/CT examinations in the whole hospital. In this study, 304 of the 486 patient were female (62.55%), 182 of them were male (37.45%), the average age of the patients was (53.21±18.81) years, and the proportion of the patients aged 45-65 (227/486, 46.71%) was the highest group. (2) Three leading purposes of the PET/CT examination in our department were to exclude cancers (55.56%), assist in diagnosis (24.60%) and evaluate the disease activity (19.84%). (3) Of the 486 patients who underwent 18F-FDG PET/CT, 327 cases might indicate a differential diagnosis of rheumatic disease, of which, 292 cases were highly suggestive of diagnosis, including 61 cases of myositis, 60 cases of vasculitis, 37 cases of adult still's disease, 32 cases of IgG4 related diseases, 30 cases of rheumatoid arthritis, 22 cases of Sjögren's syndrome, 22 cases of systemic lupus erythematosus, and 9 cases of rheumatic polymyalgia; the remaining 35 cases only prompted the possibility of autoimmune disease. Of the 486 patients, 74 cases suggested the diagnosis of cancers, 25 cases indicated the diagnosis of infectious diseases, while 60 cases could not show any diagnostic values. Ten patients with rheumatic disease were followed up with a post-treatment repeat PET/CT, and the findings in remission showed reduced 18F-FDG metabolic activity as well as a reduction in the extent of metabolic hypertrophic lesions. Conclusion: There are some typical sign of 18F-FDG PET/CT for diffuse connective tissue diseases, therefore 18F-FDG PET/CT has auxi-liary effect on the classification diagnosis of rheumatic diseases, especially for the exclusion of cancers.

Key words: Fluorodeoxyglucose F18, Positron emission tomography computed tomography, Rheumatic disease, Differential diagnosis

CLC Number: 

  • R593.2

Table 1

Age and gender composition of patients underwent 18F-FDG PET/CT examination"

Age/years Total Male, n (%) Female, n (%) Z P
< 45 136 45 (33.09) 91 (66.91)
45-65 227 87 (38.33) 140 (61.67) 1.268 0.898
>65 123 50 (40.65)

Table 2

Disease distribution of 18F-FDG PET/CT imaging diagnosis in the in-patients of rheumatology and immunology department"

Diagnostic classification n %
Infectious diseases 25 5.14
  Lung infection 8 1.65
  Necrotizing lymphadenitis 4 0.82
  Brucella infection 2 0.41
  Bone and joint prosthesis infection 1 0.21
  Kidney abscess 1 0.21
  Unknown location 9 1.85
Rheumatic diseases 327 67.28
  Dermatomyositis 45 9.26
  Adult onset Still’s disease 37 7.61
  IgG4 related disease 32 6.58
  Rheumatoid arthritis 30 6.17
  Takayasu’s arteritis 25 5.14
  Sjögren’s syndrome 22 4.53
  Systemic lupus erythematosus 22 4.53
  Behcet syndrome 14 2.88
  ANCA-associated vasculitis 10 2.06
  Polymyalgia rheumatica 9 1.85
  Retroperitoneal fibrosis 8 1.65
  Systemic sclerosis 4 0.82
  Other types of inflammatory myopathy 16 3.29
  Other types of systemic vasculitis 11 2.26
  Other types of arthritis 7 1.44
  Other connective tissue diseases 35 7.20
Cancers 74 15.23
  Lymphoma 33 6.79
  Lung cancer 13 2.67
  Genitourinary tumors 8 1.65
  Hematologic tumors 6 1.23
  Gastrointestinal tumors 4 0.82
  Other types of malignant tumors 10 2.06
No clear indications 60 12.35

Table 3

The purpose of performing 18F-FDG PET/CT examination in the in-patients of rheumatology and immunology department"

Diseases Total Exclude cancers, n (%) Assist in diagnosis, n (%) Evaluate condition, n (%)
Myositis 61 53 (86.89) 7 (11.48) 1 (1.64)
Adult onset Still’s disease 37 20 (54.05) 16 (43.24) 1 (2.70)
IgG4 related disease 32 9 (28.13) 10 (31.25) 13 (40.63)
Rheumatoid arthritis 30 20 (66.67) 10 (33.33) 0 (0)
Takayasu’s arteritis 25 3 (12.00) 1 (4.00) 21 (84.00)
Sjögren’s syndrome 22 16 (72.73) 5 (22.73) 1 (4.55)
Systemic lupus erythematosus 22 14 (63.64) 5 (22.73) 3 (13.64)
Behcet syndrome 14 1 (7.14) 3 (21.43) 10 (71.43)
Polymyalgia rheumatica 9 4 (44.44) 5 (55.56) 0 (0)

Figure 1

Radiographic characteristics of 18F-FDG PET/CT in Takayasu's arteritis Uptake of FDG (SUVmax 7.6) on the area of aortic arches was indicated by arrow. FDG, flurodeoxyglucose; SUVmax, maximum standard uptake value."

Figure 2

Radiographic characteristics of 18F-FDG PET/CT in dermatomyositis Diffuse uptake of FDG (SUVmax 5.3) on muscles, especially proximal upper and lower limbs, were indicated by arrows. Abbreviations as in Figure 1."

Figure 3

Radiographic characteristics of 18F-FDG PET/CT in adult onset Still's disease 3, uptake of FDG (SUVmax 9.3) on lymph nodes of bilateral neck and armpit, as well as spleen, were indicated by arrows."

Figure 4

Radiographic characteristics of 18F-FDG PET/CT in polymyalgia rheumatica 4, uptake of FDG (SUVmax 1.7-5.1) on shoulders, hips, knees, and ischium area were indicated by arrows. Abbreviations as in Figure 1."

Figure 5

Radiographic characteristics of 18F-FDG PET/CT in Sjögren's syndrome Uptake of FDG (SUVmax 3.2) on bilateral parotid glands were indicated by arrows. Abbreviations as in Figure 1."

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