The assessment of biologic treatment in patients with rheumatoid arthritis using FDG-PET/CT

Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma 371-8511, Japan.
Rheumatology (Oxford, England) (Impact Factor: 4.48). 04/2012; 51(8):1484-91. DOI: 10.1093/rheumatology/kes064
Source: PubMed


To evaluate whether there is a correlation between the differences in joint uptake of 2-[18F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) and the improvement of clinical findings in RA patients undergoing anti-TNF therapies.
Twenty-two patients who received anti-TNF therapies, including infliximab for 16 patients and etanercept for 6 patients, were assessed. PET with (18)F-FDG studies and clinical assessments were performed at baseline and 6 months after the initiation of therapy. The maximal standardized uptake value (SUV(max)) was used as a representative value for the assessment of the FDG uptake in the bilateral shoulder, elbow, wrist, hip, knee and ankle joints. Spearman's rank correlation test was applied to assess the correlation between the SUV and the clinical parameters.
The ΔSUV (12 joints), the difference in the SUV(max) of the affected 12 joints before and after treatment, was positively correlated with the ΔDAS28 (r = 0.609, P = 0.003), ΔDAS28-CRP (r = 0.656, P = 0.001) and Δtender joint count (TJC) (r = 0.609, P = 0.003). There were also significantly positive correlations between ΔSUV (8 joints); the difference in the SUV(max) of the bilateral shoulder, elbow, wrist and knee joints before and after treatment and the ΔDAS28 (r = 0.642, P = 0.001), ΔDAS28-CRP (r = 0.712, P < 0.001) and ΔTJC (r = 0.608, P = 0.003), respectively.
The FDG uptake observed in the inflamed RA joints may reflect disease activity. The FDG-PET response was correlated with the clinical response to the biologic treatment of RA.

1 Follower
9 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: This study aimed to determine whether [(18)F]fluorodeoxyglucose-PET/CT ([(18)F]FDG-PET/CT) discriminates PM/DM from non-muscular diseases and also whether FDG uptake in proximal muscles reflects the activity and severity of muscular inflammation in PM/DM. Methods: Twenty treatment-naïve PM/DM patients who underwent [(18)F]FDG-PET/CT were retrospectively identified by reviewing medical records. The same number of age- and sex-matched control patients with non-muscular diseases were also identified. Standardized uptake value (SUV) was calculated for each of the seven proximal muscles. For patient-based assessment, mean proximal muscle SUV was calculated by averaging the SUVs for these proximal muscles bilaterally. Results: Mean proximal muscle SUVs were significantly greater in PM/DM patients than in control patients (median 1.05 vs 0.69, P < 0.001). Mean proximal muscle SUVs significantly correlated with mean proximal manual muscle test scores (ρ = 0.49, P = 0.028) and serum levels of creatine kinase (ρ = 0.54, P = 0.015) and aldolase (ρ = 0.64, P = 0.002). Furthermore, SUVs in proximal muscles from which biopsy specimens were obtained significantly correlated with histological grade for inflammatory cell infiltration (ρ = 0.66, P = 0.002). Conclusion: Our results suggest that [(18)F]FDG-PET/CT is useful in the diagnosis of PM/DM when inflammation in proximal muscles is globally assessed with quantitative measurements. Our results also indicate that local FDG uptake in a proximal muscle reflects the activity of inflammation in the same muscle and provides useful information in determining the region for muscle biopsy.
    Rheumatology (Oxford, England) 03/2013; 52(7). DOI:10.1093/rheumatology/ket112 · 4.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine the current status of positron emission tomography (PET) as a tool for diagnosis and monitoring of peripheral inflammatory arthritis (IA). Methods For conducting this systematic review, the PubMed (Medline), Embase, and Cochrane Library databases were searched until December 31, 2012. Studies of PET for diagnosis and/or therapy monitoring of peripheral IA were included. Data were summarized qualitatively using best evidence synthesis. ResultsEighteen articles met our inclusion criteria. The majority of studies were feasibility studies with varying methods applied. All studies demonstrated that PET visualized IA with high sensitivity, corresponding to clinical assessments. PET outcome of clinically active IA also matched that of ultrasound and magnetic resonance imaging. PET differentiates from other modalities by (quantitative) imaging of molecular sites in the synovium. The first studies reporting on the potential clinical applications of PET to image subclinical synovitis in preclinical RA and during therapy have been published. The results are promising, but the number and study populations of these studies are still limited. Conclusion Thus far, a limited number of PET studies addressing IA imaging have been published. The PET modality seems to offer highly sensitive and potentially specific imaging of IA at the (quantitative) molecular level. Clinical application studies for early diagnostics and therapy monitoring are arising, but these topics should be further explored in future studies with larger cohorts. For integration in clinical practice, aspects such as radiation burden and cost-effectiveness should also be taken into account.
    01/2014; 66(1). DOI:10.1002/acr.22184
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to evaluate the lesion frequency and incremental added benefit with "true whole-body" (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) of distal lower extremities. We compared this field of view with the typical whole-body view, from head to upper thighs, in numerous patients with known or suspected malignancy. True whole-body (18)F-FDG PET/CT, from the top of the head to the bottom of the feet, was performed on 4574 consecutively registered patients with known or suspected malignancy. Using a variable sampling method, the PET images of head and torso were acquired for 90 s per bed position, and the images of lower extremities were acquired for 30 s per position, thus requiring between 22 and 24 min of emission scanning per patient. A log was maintained to record cases of abnormal findings in distal lower extremities outside the typical whole-body field of view. Suspected malignant lesions in distal lower extremities were verified by correlation with pathological findings and clinical follow-up. Abnormal findings in distal lower extremities were found in 647 (14.1 %; 95 % CI 13.1-15.2 %) of 4574 examinations. Increased FDG uptake was found in 559 examinations (12.2 %; 95 % CI 11.3-13.2 %). Lesions appeared malignant or equivocal in 67 examinations (1.5 %; 95 % CI 1.1-1.8 %) on the PET images. In 42 (0.9 %; 95 % CI 0.6-1.2 %) of 4574 examinations, these lesions were pathologically or clinically proven to be malignant. Detection of these malignancies resulted in changing clinical management in 21 (50 %) of 42 examinations. Definitive benign lesions were found in 492 examinations (10.7 %; 95 % CI 9.9-11.7 %) on the PET images. Abnormal findings were noted in 90 examinations (2.0 %; 95 % CI 1.6-2.4 %) consisting of 88 benign and 2 malignancies on the CT images alone. True whole-body (18)F-FDG PET/CT was not of high yield and appears to offer little additional benefit, as to detection of additional metastases and involvement, but it may affect clinical management in patients with known or suspected malignancy.
    Annals of Nuclear Medicine 02/2014; 28(4). DOI:10.1007/s12149-014-0814-0 · 1.68 Impact Factor
Show more


9 Reads
Available from