Skip to main content
SpringerLink
Log in

18F-FDG PET/CT in patients with adult-onset Still’s disease

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has become useful for the detection and diagnosis of inflammatory conditions, including rheumatic diseases, immunoglobulin (Ig) G4-related disease and giant cell arteritis. However, few articles based on small sample sizes (n = 7) diagnosed as adult-onset Still’s disease (AOSD) have been published. The study aim was to observe the reliable characteristics and usefulness of 18F-FDG PET/CT for the evaluation of consecutive patients with AOSD. Eligible patients were selected from among those who had undergone 18F-FDG PET/CT between May 2007 and June 2014. Twenty-six consecutive AOSD patients were recruited retrospectively according to criteria set by Yamaguchi et al. All patients underwent evaluation by 18F-FDG PET/CT. The characteristics and usefulness of 18F-FDG PET/CT for evaluation of consecutive patients with AOSD were evaluated. All 26 patients had 18F-FDG-avid lesion(s) related to their particular disease. Diffuse and homogeneous accumulation of 18F-FDG was seen in the bone marrow (26/26; 100 %; maximum standardized uptake (SUVmax), 2.10–6.73) and spleen (25/26; 96.15 %). The SUVmax of affected lymph nodes was 1.3–9.53 (mean ± SD, 4.12 ± 2.24). The SUVmax and size factors (maximum diameter and areas) of affected lymph nodes were significantly different (P = 0.033 and P = 0.012, respectively). 18F-FDG PET/CT showed the general distribution of 18F-FDG accumulation. This factor helped to exclude malignant disease and aided the diagnosis of AOSD (42.3 %) in 11 cases when combined with clinical features and aided decisions regarding appropriate biopsy sites, such as the lymph nodes (n = 9) and bone marrow (n = 13). 18F-FDG PET/CT is a unique imaging method for the assessment of metabolic activity throughout the body in subjects with AOSD. Characteristics or patterns of AOSD observed on 18F-FDG PET/CT can be used for the indication and diagnosis or to guide the clinical management of ASOD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Mahroum N, Mahagna H, Amital H (2014) Diagnosis and classification of adult Still’s disease. J Autoimmun 48–49:34–37

    Article  PubMed  Google Scholar 

  2. Efthimiou P, Paik PK, Bielory L (2006) Diagnosis and management of adult onset Still’ s disease. Ann Rheum Dis 65:564–572

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Besson FL, de Boysson H, Parienti JJ, Bouvard G, Bienvenu B, Agostini D (2014) Towards an optimal semiquantitative approach in giant cell arteritis: an (18)F-FDG PET/CT case–control study. Eur J Nucl Med Mol Imaging 41:155–166

    Article  PubMed  Google Scholar 

  4. Gupta P, Ponzo F, Kramer EL (2005) Fluorodeoxyglucose (FDG) uptake in pulmonary rheumatoid nodules. Clin Rheumatol 24:402–405

    Article  PubMed  Google Scholar 

  5. Moreno D, Yuste JR, Rodriguez M, García-Velloso MJ, Prieto J (2005) Positron emission tomography use in the diagnosis and follow up of Takayasu’s arteritis. Ann Rheum Dis 64:1091–1093

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Blockmans D, de Ceuninck L, Vandershueren S, Knockaert D, Mortelmans L, Bobbaers H (2006) Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients. Arthritis Rheum 55:131–137

    Article  PubMed  Google Scholar 

  7. Takahashi H, Yamashita H, Morooka M, Kubota K, Takahashi Y, Kaneko H, Kano T, Mimori A (2014) The utility of FDG-PET/CT and other imaging techniques in the evaluation of IgG4-related disease. Joint Bone Spine 81(4):331–336

    Article  PubMed  Google Scholar 

  8. Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H et al (1992) Preliminary criteria for classification of adult Still’s disease. J Rheumatol 19:424–430

    CAS  PubMed  Google Scholar 

  9. Gerfaud-Valentin M, Maucort-Boulch D, Hot A, Iwaz J, Ninet J, Durieu I, Broussolle C, Sève P (2014) Adult-onset still disease: manifestations, treatment, outcome, and prognostic factors in 57 patients. Medicine (Baltimore) 93:91–99

    Article  CAS  Google Scholar 

  10. Kurasawa M, Kotani K, Kurasawa G, Shida K, Yamada S, Tago T (2007) Adult-onset Still’s disease in a patient over 80 years old successfully treated with low-dose methotrexate therapy. Age Ageing 36:104–106

    Article  PubMed  Google Scholar 

  11. Ichiki H, Shishido M, Nishiyama S (1992) Two cases of adult onset of Still’s disease in the elderly. Nihon Ronen Igakkai Zasshi 29:960–964

    Article  CAS  PubMed  Google Scholar 

  12. Mavragani CP, Spyridakis EG, Koutsilieris M (2012) Adult-onset still’s disease: from pathophysiology to targeted therapies. Int J Inflamm 2012:879020

    Article  Google Scholar 

  13. Nagai Y, Hasegawa M, Okada E, Hattori T, Tago O, Ishikawa O (2012) Clinical follow-up study of adult-onset Still’s disease. J Dermatol 39:898–901

    Article  PubMed  Google Scholar 

  14. Bagnari V, Colina M, Ciancio G, Govoni M, Trotta F (2010) Adult-onset still’s disease. Rheumatol Int 30:855–862

    Article  CAS  PubMed  Google Scholar 

  15. Nishiyama Y, Yamamoto Y, Dobashi H, Kameda T (2010) Clinical value of 18F-fluorodeoxyglucose positron emission tomography in patients with connective tissue disease. Jpn J Radiol 28:405–413

    Article  PubMed  Google Scholar 

  16. Glaudemans AW, de Vries EF, Galli F, Dierckx RA, Slart RH, Signore A (2013) The use of (18)F-FDG-PET/CT for diagnosis and treatment monitoring of inflammatory and infectious diseases. Clin Dev Immunol 2013:623036

    Article  PubMed Central  PubMed  Google Scholar 

  17. Yamashita H, Kubota K, Takahashi Y, Minamimoto R, Morooka M, Kaneko H, Kano T, Mimori A (2014) Clinical value of 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography in patients with adult-onset Still’s disease: a seven-case series and review of the literature. Mod Rheumatol 24:645–650

    Article  PubMed  Google Scholar 

  18. de Graaff LC, ten Broek MR, Schweitzer DH (2012) Is Still’s disease still one disease? A case of adult-onset Still’s disease showing accumulation in the carotids and the large vessels of the legs on positron emission tomography: CT images. Rheumatol Int 32:2487–2490

    Article  PubMed  Google Scholar 

  19. Funauchi M, Ikoma S, Kishimoto K, Shimazu H, Nozaki Y, Sugiyama M, Kinoshita K (2008) A case of adult onset Still’s disease showing marked accumulation in the liver and spleen, on positron emission tomography-CT images. Rheumatol Int 28:1061–1064

    Article  PubMed  Google Scholar 

  20. Choe JY, Chung DS, Park SH, Kwon HH, Kim SK (2010) Clinical significance of 18F-fluoro-dexoxyglucose positron emission tomography in patients with adult-onset Still’s disease: report of two cases and review of literatures. Rheumatol Int 30:1673–1676

    Article  PubMed  Google Scholar 

  21. Murata Y, Kubota K, Yukihiro M, Ito K, Watanabe H, Shibuya H (2006) Correlations between 18F-FDG uptake by bone marrow and hematological parameters: measurements by PET/CT. Nucl Med Biol 33:999–1004

    Article  CAS  PubMed  Google Scholar 

  22. Paes FM, Kalkanis DG, Sideras PA, Serafini AN (2010) FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. Radiographics 30:269–291

    Article  PubMed  Google Scholar 

  23. Cremers JP, Van Kroonenburgh MJ, Mostard RL, Vöö SA, Wijnen PA, Koek GH, Drent M (2014) Extent of disease activity assessed by 18F-FDG PET/CT in a Dutch sarcoidosis population. Sarcoidosis Vasc Diffuse Lung Dis 31:37–45

    PubMed  Google Scholar 

  24. Oh JR, Song HC, Kang SR, Yoo SW, Kim J, Chong A, Min JJ, Bom HS, Lee SS, Park YW (2011) The clinical usefulness of (18) F-FDG PET/CT in patients with systemic autoimmune disease. Nucl Med Mol Imaging 45:177–184

    Article  PubMed Central  PubMed  Google Scholar 

  25. Dong MJ, Zhao K, Liu ZF, Wang GL, Yang SY, Zhou GJ (2011) A meta-analysis of the value of fluorodeoxyglucose-PET/PET-CT in the evaluation of fever of unknown origin. Eur J Radiol 80:834–844

    Article  PubMed  Google Scholar 

  26. Nilegaonkar S, Karekar R, Hirawe D, Lagade S (2012) Adult onset Still’s disease: role of scintigraphy. Indian J Nucl Med 27:48–49

    Article  PubMed Central  PubMed  Google Scholar 

  27. Takeshita T, Kaminaga T, Ohkuma M, Furui S (2006) Adult-onset Still’s disease: evaluation by gallium-67 citrate scintigraphy. Intern Med 45:937–938

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the National Natural Science Foundation of China (No. 81471704), the Science and Technology Planning Project of Zhejiang Province (2013C33119) and the Health Bureau Project of Zhejiang Province (2013KYA069, 2013ZDA008).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003, People’s Republic of China

    Meng-Jie Dong, Kui Zhao, Guo-Lin Wang, Mei-Ling Sun & Zhen-Feng Liu

  2. Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Women’s Reproductive Health Key Laboratory of Zhejiang Province, Zhejiang, 310003, People’s Republic of China

    Cai-qin Wang

  3. Rheumatology Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003, People’s Republic of China

    Liqin Xu

Authors
  1. Meng-Jie Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cai-qin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kui Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guo-Lin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mei-Ling Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhen-Feng Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Liqin Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhen-Feng Liu.

Additional information

Meng-Jie Dong and Cai-qin Wang contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dong, MJ., Wang, Cq., Zhao, K. et al. 18F-FDG PET/CT in patients with adult-onset Still’s disease. Clin Rheumatol 34, 2047–2056 (2015). https://doi.org/10.1007/s10067-015-2901-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-015-2901-6

Keywords

Search

Navigation