18F-Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography With Magnetic Resonance for Diagnosing Adult-Onset Still's Disease

Abstract

The objective of the study was to assess the advantages of 18 F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography with magnetic resonance (PET/CT-MR) in diagnosing and monitoring patients with adult-onset Still's disease (AOSD). Methods: Participants in this retrospective case-control study underwent whole-body 18 F-FDG-PET/CT-MR imaging. All PET scans were qualitatively and semiquantitatively analyzed using standardized uptake values (SUVs) normalized to liver uptake, i.e., we calculated the ratio (SUVr) between the minimum, maximum, and mean SUVs for different organs and tissues and the mean SUV for the liver. Disease activity scores were assessed using Pouchot's criteria. Results: Eighteen patients diagnosed with AOSD and 24 controls (non-AOSD patients diagnosed with solid tumors, excluding lymphomas) were considered. A total of 38 PET/MR and nine PET/CT scans were analyzed. AOSD patients had higher SUVr than controls. All SUVr differed significantly between the patient and control group for bone marrow, and for the spleen, the only difference lacking statistical significance concerned the ratio of the minimum SUV for spleen to the mean SUV for liver. Though limited in number, AOSD responders to therapy showed lower uptakes during the period monitored. No correlations were found between Pouchot's scores and SUVr. Conclusion: Our data revealed higher spleen and bone marrow 18 F-FDG uptakes on PET/CT and PET/MR images in AOSD patients than in controls. Together with clinical examinations and laboratory data, PET/CT and PET/MR seemed more reliable than Pouchot's score in assessing disease activity.

Characteristics and Clinical Value of 18F-FDG PET/CT in the Management of Adult-Onset Still’s Disease: 35 Cases

“…PET/CT showed homogeneous and diffuse bone marrow hypermetabolism in 75% of the patients, confirming data from the main published studies, in which the bone marrow intensely fixed the marker in 80%–100% of cases [ 9 , 10 , 11 , 12 , 23 , 24 , 25 ]. This diffuse uptake is probably related to inflammatory parameters reflecting the cellular activation within the bone marrow [ 26 ].…”

“…The examinations showed at least one hypermetabolic lymph node site at the same rate as in the published data (67–84% of cases) [ 9 , 11 , 12 , 24 , 25 ]. Hypermetabolic lymph nodes were preferentially supradiaphragmatic in our study.…”

Diagnosis and treatment of adult-onset Still’s disease: a concise summary of the German society of rheumatology S2 guideline

“…Besides thediagnostic procedures mentioned in the recommendations, data also exist on the utility of procedures such as positron-emission tomography (PET) with or without computed tomography (PET-CT) [8,21,86,155,180], as well as on biopsies of liver [9], skin [64,96,116,120,131,167,214], mucous membranes [181], lymph nodes [84], and bone marrow [138], all of which may have a role in the differential diagnostic process of individual patients. Furthermore, multiple biomarkers other than ferritin or IL-18 have been assessed [16, 19, 30, 32-38, 38-41, 43, 45, 68, 74-76, 79, 88, 95, 101, 102, 104, 108, 135, 160, 161, 186, 188, 197], but validation studies are largely lacking.…”

Adult-Onset Still’s Disease (AOSD): Advances in Understanding Pathophysiology, Genetics and Emerging Treatment Options

“…X-rays or ultrasounds have proven to be unhelpful in the diagnostic process and no radiological criteria for AOSD exist. However, it was reported that the employment of 18 F-fluoro-2-deoxyglucose ( 18 F-FDG) positron emission tomography (PET) with computed tomography (CT) or magnetic resonance (MR) may support AOSD diagnosis and response to therapy [ 77 ]. Although a specific uptake cannot be detected and the differential diagnosis with haematological malignancies is mandatory, subjects with AOSD usually present with higher 18 F-FDG uptake than non-AOSD in specific areas, namely bone marrow, spleen and lymph nodes [ 77 ].…”

“…However, it was reported that the employment of 18 F-fluoro-2-deoxyglucose ( 18 F-FDG) positron emission tomography (PET) with computed tomography (CT) or magnetic resonance (MR) may support AOSD diagnosis and response to therapy [ 77 ]. Although a specific uptake cannot be detected and the differential diagnosis with haematological malignancies is mandatory, subjects with AOSD usually present with higher 18 F-FDG uptake than non-AOSD in specific areas, namely bone marrow, spleen and lymph nodes [ 77 ]. The qualitative analysis, usually performed by an expert nuclear medicine radiologist, is essential for detecting active areas, whereas the quantitative analysis, through the assessment of standardised uptake values (SUVs), is important to establishing and quantifying hypermetabolic areas.…”