Is 18 F-FDG PET/CT useful for diagnosing relapsing polychondritis with airway involvement and monitoring response to steroid-based therapy?
Arthritis Research & Therapy(2019)
摘要
Background 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a promising tool for diagnosing relapsing polychondritis (RP). However, its usefulness in assessing RP with airway involvement is unknown. Objective This study aimed to further evaluate and confirm the potency of 18 F-FDG PET/CT in diagnosing RP with airway involvement and monitoring response to steroid-based therapy. Methods A total of 30 patients from a dedicated respiratory centre, diagnosed with RP in accordance with McAdam, Damiani or Levine criteria, were included in this study. All patients underwent baseline 18 F-FDG PET/CT, and 10 patients underwent second scans after 2.5–15 months of steroid-based therapy. Visual scores (VS) and maximal standard uptake values (SUV max ) were analysed. Results In the initial scan, 83.3% (25/30) of patients were found to have FDG uptake in more than one cartilage. The median VS and SUV max in the cartilages were 3 (range, 1–3) and 3.8 (range, 1.9–17.9), respectively. Positive rates for PET/CT-guided biopsy in nasal, auricular, and tracheal/bronchial cartilages were 100% (5/5), 88.9% (8/9), and 10.5% (2/19), respectively, but the positive biopsy rate in the auricular cartilage was 92.3% (12/13) even without PET/CT assessment. Based on biopsy-proven sites, the sensitivity of PET/CT was 55.6%, and the specificity was 5.3%. Compared with the baseline scan, the second scan showed much lower median VS (2 vs 3, respectively; p < 0.0001) and SUV max (2.9 vs 3.8, respectively; p < 0.001). Of 10 patients who underwent second PET/CT, 8 had complete therapeutic response, while 2 had partial response. Conclusion 18 F-FDG PET/CT assists in identifying multiple cartilage involvement in RP, but it seems neither a sensitive nor specific modality in diagnosing RP with airway involvement. Moreover, PET/CT has limited utility in locating biopsy sites and monitoring therapeutic response to corticosteroids.
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关键词
18F-FDG PET/CT,Relapsing polychondritis,Cartilage,Airway involvement,Corticosteroid,Response to therapy
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