¹⁸F-FDG PET/CT Useful for the Early Detection of Rapidly Progressive Fatal Interstitial Lung Disease in Dermatomyositis

Abstract

Interstitial lung disease (ILD) frequently accompanies polymyositis (PM) and dermatomyositis (DM) and is a major cause of mortality. The rapid diagnosis of ILD is paramount. However, the early changes of presymptomatic ILD are difficult to detect. We present a patient with DM who had positive uptake in the lung of FDG-PET/CT as well as 'mechanic's hands' appearance, increased serum ferritin and serum anti-CADM-140 antibody, all before the detection of ILD by CT. Although aggressive treatment was initiated, the patient died of diffuse alveolar damage. These observations suggest that the pulmonary uptake of 18 F-FDG predicts rapidly progressive ILD in DM.

Clinical value of 18F‐fluorodeoxyglucose positron emission tomography/computed tomography for interstitial lung disease and myositis in patients with dermatomyositis

“…Furthermore, the FDG uptake is also observed in inflammatory cells. Morita et al 11 reported the usefulness of FDG-PET/CT for the detection of early inflammation in ILD in patients with DM. 6,22,23 Regarding the ILD, several studies reported the usefulness of FDG-PET/CT for the detection of ILD in DM patients.…”

“…6,22,23 Regarding the ILD, several studies reported the usefulness of FDG-PET/CT for the detection of ILD in DM patients. Morita et al 11 reported the usefulness of FDG-PET/CT for the detection of early inflammation in ILD in patients with DM. Uehara et al 24 reported that FDG-PET/CT procedure sensitively illustrated active ILD lesions in connective tissue diseases, including DM.…”

“…18 F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is usually used to screen malignancy in patients with DM. 7,8 Regarding FDG-PET and ILD in DM, Morita et al 11 reported only one case that FDG-PET/CT showed a positive accumulation at the periphery of the lungs bilaterally before the detection of ILD by CT. Therefore, FDG-PET/CT provides valuable information for evaluating the activity of several inflammatory diseases, such as sarcoidosis, atherosclerosis, inflammatory bowel disease and rheumatoid arthritis.…”

“…[7][8][9][10] However, several studies demonstrated that elevated FDG uptake in muscle did not correlate with MRI findings and serum levels of skeletal muscle-derived enzymes. 7,8 Regarding FDG-PET and ILD in DM, Morita et al 11 reported only one case that FDG-PET/CT showed a positive accumulation at the periphery of the lungs bilaterally before the detection of ILD by CT. In the present study, the objective was to evaluate the usefulness of FDG-PET/CT for the detection of inflammatory lesions and disease activity of both myopathy and ILD in DM patients.…”

Interstitial Lung Disease and Rheumatoid Arthritis: A Review

“…In a case report, 18F-FDG PET/CT was used to screen for malignancy in a patient with clinically amyopathic dermatomyositis (CADM), and this showed 18F-FDG being distributed peripherally in both lungs, despite the absence of ILD on HRCT and normal arterial blood gases 53 . Despite aggressive immunosuppression, the patient later developed rapidly progressive ILD and died.…”