18F-FDG PET of the hands with a dedicated high-resolution PEM system (arthro-PET): correlation with PET/CT, radiography and clinical parameters

Abstract

Purpose The aim of this study was to prospectively determine the feasibility and compare the novel use of a positron emission mammography (PEM) scanner with standard PET/CT for evaluating hand osteoarthritis (OA) with 18F-FDG. Methods Institutional review board approval and written informed consent were obtained for this HIPAA-compliant prospective study in which 14 adults referred for oncological 18F-FDG PET/CT underwent dedicated hand PET/CT followed by arthro-PET using the PEM device. Hand radiographs were obtained and scored for the presence and severity of OA. Summed qualitative and quantitative joint glycolytic scores for each modality were compared with the findings on plain radiography and clinical features. Results Eight patients with clinical and/or radiographic evidence of OA comprised the OA group (mean age 73±7.7 years). Six patients served as the control group (53.7±9.3 years). Arthro-PET quantitative and qualitative joint glycolytic scores were highly correlated with PET/CT findings in the OA patients (r=0.86. p =0.007; r=0.94, p=0.001). Qualitative arthro-PET and PET/CT joint scores were significantly higher in the OA patients than in controls (38.7±6.6 vs. 32.2±0.4, p=0.02; 37.5±5.4 vs. 32.2±0.4, p=0.03, respectively). Quantitative arthro-PET and PET/CT maximum SUV-lean joint scores were higher in the OA patients, although they did not reach statistical significance (20.8±4.2 vs. 18±1.8, p= 0.13; 22.8±5.38 vs. 20.1±1.54, p=0.21). By definition, OA patients had higher radiographic joint scores than controls (30.9±31.3 vs. 0, p=0.03). Conclusion Hand imaging using a small field of view PEM system (arthro-PET) with FDG is feasible, performing comparably to PET/CT in assessing metabolic joint activity. Arthro-PET and PET/CT showed higher joint FDG uptake in OA. Further exploration of arthro-PET in arthritis management is warranted.

18F-FDG and 18F-NaF PET/CT demonstrate coupling of inflammation and accelerated bone turnover in rheumatoid arthritis

“…However, typical OA lesions ( Figure 1B, in DIP joints) incorporated 18 F-NaF but not 18 F-FDG, though DIP joints were not systematically assessed in this study. Moreover, according to previous reports, some OA lesions take up 18 F-FDG [34,38]; therefore, secondary synovitis is likely accompanied by OA.…”

“…Specificity to detect bone lesions is greatly improved by introduction of SPECT/CT, but further significantly improved with use of 18 F-NaF PET/CT [23,34].…”

“…The issue is one of the major limitations of PET/CT in small joint analysis. Recent pilot studies have shown that spatial resolution of PET image in hand small joints is improved by use of dedicated PET imaging devices [34], or high-resolution PET with MRI scanner [40].…”

High-resolution18F-FDG PET/CT for assessing disease activity in rheumatoid and psoriatic arthritis: findings of a prospective pilot study

“…The system provided tomographic sampling, and attenuation and scatter correction of PET data employed the co-registered CT image. Recently, the feasibility of the quad-highdensity avalanche chamber nano-PET small-animal system, 31 the positron emission mammography Flex Solo II system 32,33 and the avalanche photodiode (APD)-based BrainPET system (Siemens Healthcare, Erlangen, Germany) 34 was demonstrated for wrist and hand arthritic imaging. These systems, however, did not have direct means for attenuation and scatter correction, and therefore radiotracer activity quantification is challenging.…”

Osteoarthritis year in review 2015: imaging

“…A study compared 18F-fluoride PET and MRI in evaluating early-stage hip OA and found 18F-fluoride PET could detect bone abnormalities earlier than MRI 17 . Another PET study reported higher joint 18F-fluorodeoxyglucose uptake in hand OA, relative to normal controls 18 . Such methodology may be useful in mechanistic studies in OA.…”