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Evolving role of FDG PET imaging in assessing joint disorders: a systematic review

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Abstract

Assessing joint disorders has been a relatively recent and evolving application of 18F-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) imaging. FDG is taken up by inflammatory cells, particularly when they are active as part of an ongoing inflammatory process. Hence FDG PET has been employed to assess a wide array of arthritic disorders. FDG PET imaging has been investigated in various joint diseases for diagnostic purposes, treatment monitoring, and as a prognostic indicator as in other disorders. In some of the diseases the ancillary findings in FDG PET have provided important clues about the underlying pathophysiology and pathogenesis processes. While substantial promise has been demonstrated in a number of studies, it is clear that the potential utility of PET in this clinical realm far outweighs that which has been established to date.

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References

  1. Bakheet SM, Powe J. Fluorine-18-fluorodeoxyglucose uptake in rheumatoid arthritis-associated lung disease in a patient with thyroid cancer. J Nucl Med 1998;39(2):234–6.

    PubMed  CAS  Google Scholar 

  2. McQueen FM, Ostergaard M. Established rheumatoid arthritis - new imaging modalities. Best Pract Res Clin Rheumatol 2007;21(5):841–56.

    Article  PubMed  Google Scholar 

  3. Mier W, Haberkorn U, Eisenhut M. [18F]FLT; portrait of a proliferation marker. Eur J Nucl Med Mol Imaging 2002;29(2):165–9.

    Article  PubMed  CAS  Google Scholar 

  4. Meller J, Sahlmann CO, Liersch T, Hau Tang P, Alavi A. Nonprosthesis orthopedic applications of (18)F fluoro-2-deoxy-D-glucose PET in the detection of osteomyelitis. Radiol Clin North Am 2007;45(33):719–33. vii-viii.

    Article  PubMed  Google Scholar 

  5. Basu S, Houseni M, Bural G, Chamroonat W, Udupa J, Mishra S, et al. Magnetic resonance imaging based bone marrow segmentation for quantitative calculation of pure red marrow metabolism using 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography: a novel application with significant implications for combined structure-function approach. Mol Imaging Biol 2007;9(6):361–5.

    Article  PubMed  Google Scholar 

  6. Basu S, Zhuang H, Torigian DA, Rosenbaum J, Chen W, Alavi A. Functional imaging of inflammatory diseases using nuclear medicine techniques. Semin Nucl Med 2009;39(2):124–45.

    Article  PubMed  Google Scholar 

  7. Zhuang H, Chacko TK, Hickeson M, Stevenson K, Feng Q, Ponzo F, et al. Persistent non-specific FDG uptake on PET imaging following hip arthroplasty. Eur J Nucl Med Mol Imaging 2002;29(10):1328–33.

    Article  PubMed  CAS  Google Scholar 

  8. Torigian DA, Huang SS, Houseni M, Alavi A. Functional imaging of cancer with emphasis on molecular techniques. CA Cancer J Clin 2007;57(4):206–24.

    Article  PubMed  Google Scholar 

  9. Beckers C, Jeukens X, Ribbens C, André B, Marcellis S, Leclercq P, et al. (18)F-FDG PET imaging of rheumatoid knee synovitis correlates with dynamic magnetic resonance and sonographic assessments as well as with the serum level of metalloproteinase-3. Eur J Nucl Med Mol Imaging 2006;33(3):275–80.

    Article  PubMed  Google Scholar 

  10. Stumpe KD, Zanetti M, Weishaupt D, Hodler J, Boos N, Von Schulthess GK. FDG positron emission tomography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR imaging. AJR Am J Roentgenol 2002;179(5):1151–7.

    PubMed  Google Scholar 

  11. Basu S, Zaidi H, Houseni M, Bural G, Udupa J, Acton P, et al. Novel quantitative techniques for assessing regional and global function and structure based on modern imaging modalities: implications for normal variation, aging and diseased states. Semin Nucl Med 2007;37(3):223–39.

    Article  PubMed  Google Scholar 

  12. Zhuang H, Sam JW, Chacko TK, Duarte PS, Hickeson M, Feng Q, et al. Rapid normalization of osseous FDG uptake following traumatic or surgical fractures. Eur J Nucl Med Mol Imaging 2003;30(8):1096–103.

    Article  PubMed  Google Scholar 

  13. Brenner W. 18F-FDG PET in rheumatoid arthritis: there still is a long way to go. J Nucl Med 2004;45(6):927–9.

    PubMed  CAS  Google Scholar 

  14. Chianelli M, D’Alessandria C, Conti F, Priori R, Valesini G, Annovazzi A, et al. New radiopharmaceuticals for imaging rheumatoid arthritis. Q J Nucl Med Mol Imaging 2006;50(3):217–25.

    PubMed  CAS  Google Scholar 

  15. Sokolove J, Strand V. Rheumatoid arthritis classification criteria - It’s finally time to move on! Bull NYU Hosp Jt Dis 2010;68(3):232–8.

    PubMed  Google Scholar 

  16. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62(9):2569–81.

    Article  PubMed  Google Scholar 

  17. Kubota K, Ito K, Morooka M, Mitsumoto T, Kurihara K, Yamashita H, et al. Whole-body FDG-PET/CT on rheumatoid arthritis of large joints. Ann Nucl Med 2009;23(9):783–91.

    Article  PubMed  Google Scholar 

  18. Wilske KR, Healey LA. Remodeling the pyramid–a concept whose time has come. J Rheumatol 1989;16(5):565–7.

    PubMed  CAS  Google Scholar 

  19. Basu S, Chryssikos T, Houseni M, Scot Malay D, Shah J, Zhuang H, et al. Potential role of FDG PET in the setting of diabetic neuro-osteoarthropathy: can it differentiate uncomplicated Charcot’s neuroarthropathy from osteomyelitis and soft-tissue infection? Nucl Med Commun 2007;28(6):465–72.

    Article  PubMed  Google Scholar 

  20. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJ, Hazes JM, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum 2005;52(11):3381–90.

    Article  PubMed  CAS  Google Scholar 

  21. Lin E, Sicuro P. FDG uptake in cervical facet subchondral cysts demonstrated by PET/CT. Clin Nucl Med 2008;33(4):268–70.

    Article  PubMed  Google Scholar 

  22. Matsui T, Nakata N, Nagai S, Nakatani A, Takahashi M, Momose T, et al. Inflammatory cytokines and hypoxia contribute to 18F-FDG uptake by cells involved in pannus formation in rheumatoid arthritis. J Nucl Med 2009;50(6):920–6.

    Article  PubMed  CAS  Google Scholar 

  23. Elzinga EH, van der Laken CJ, Comans EF, Lammertsma AA, Dijkmans BA, Voskuyl AE. 2-Deoxy-2-[F-18]fluoro-D-glucose joint uptake on positron emission tomography images: rheumatoid arthritis versus osteoarthritis. Mol Imaging Biol 2007;9(6):357–60.

    Article  PubMed  CAS  Google Scholar 

  24. Beckers C, Ribbens C, André B, Marcelis S, Kaye O, Mathy L, et al. Assessment of disease activity in rheumatoid arthritis with (18)F-FDG PET. J Nucl Med 2004;45(6):956–64.

    PubMed  CAS  Google Scholar 

  25. Roivainen A, Parkkola R, Yli-Kerttula T, Lehikoinen P, Vilanen T, Möttönen T, et al. Use of positron emission tomography with methyl-11C-choline and 2-18F-fluoro-2-deoxy-D-glucose in comparison with magnetic resonance imaging for the assessment of inflammatory proliferation of synovium. Arthritis Rheum 2003;48(11):3077–84.

    Article  PubMed  CAS  Google Scholar 

  26. Ostergaard M, Stoltenberg M, Løvgreen-Nielsen P, Volck B, Sonne-Holm S, Lorenzen I. Quantification of synovistis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation. Magn Reson Imaging 1998;16(7):743–54.

    Article  PubMed  CAS  Google Scholar 

  27. Palmer WE, Rosenthal DI, Schoenberg OI, Fischman AJ, Simon LS, Rubin RH, et al. Quantification of inflammation in the wrist with gadolinium-enhanced MR imaging and PET with 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 1995;196(3):647–55.

    PubMed  CAS  Google Scholar 

  28. Ju JH, Kang KY, Kim IJ, Yoon JU, Kim HS, Park SH, et al. Visualization and localization of rheumatoid knee synovitis with FDG-PET/CT images. Clin Rheumatol 2008;27 Suppl 2:S39–41.

    Article  PubMed  Google Scholar 

  29. Altman R, Asch E, Block D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986;29(8):1039–49.

    Article  PubMed  CAS  Google Scholar 

  30. Kaneta T, Hakamatsuka T, Yamada T, Takase K, Sato A, Higano S, et al. Atlantoaxial osteoarthritis in rheumatoid arthritis: FDG PET/CT findings. Clin Nucl Med 2006;31(4):209.

    Article  PubMed  Google Scholar 

  31. Paulus HE, Egger MJ, Ward JR, Williams HJ. Analysis of improvement in individual rheumatoid arthritis patients treated with disease-modifying antirheumatic drugs, based on the findings in patients treated with placebo. The Cooperative Systematic Studies of Rheumatic Diseases Group. Arthritis Rheum 1990;33(4):477–84.

    Article  PubMed  CAS  Google Scholar 

  32. Polisson RP, Schoenberg OI, Fischman A, Rubin R, Simon LS, Rosenthal D, et al. Use of magnetic resonance imaging and positron emission tomography in the assessment of synovial volume and glucose metabolism in patients with rheumatoid arthritis. Arthritis Rheum 1995;38(6):819–25.

    Article  PubMed  CAS  Google Scholar 

  33. Goerres GW, Forster A, Uebelhart D, Seifert B, Treyer V, Michel B, et al. F-18 FDG whole-body PET for the assessment of disease activity in patients with rheumatoid arthritis. Clin Nucl Med 2006;31(7):386–90.

    Article  PubMed  Google Scholar 

  34. Sato J, Watanabe H, Shinozaki T, Fukuda T, Shirakura K, Takagishi K. Gouty tophus of the patella evaluated by PET imaging. J Orthop Sci 2001;6(6):604–7.

    Article  PubMed  CAS  Google Scholar 

  35. Wunder A, Straub RH, Gay S, Funk J, Müller-Ladner U. Molecular imaging: novel tools in visualizing rheumatoid arthritis. Rheumatology (Oxford) 2005;44(11):1341–9.

    Article  CAS  Google Scholar 

  36. Linn-Rasker SP, van der Helm-van Mil AH, Breedveld FC, Huizinga TW. Arthritis of the large joints - in particular, the knee - at first presentation is predictive for a high level of radiological destruction of the small joints in rheumatoid arthritis. Ann Rheum Dis 2007;66(5):646–50.

    Article  PubMed  CAS  Google Scholar 

  37. Pelletier JP, Martel-Pelletier J, Abramson SB. Osteoarthritis, an inflammatory disease: potential implication for the selection of new therapeutic targets. Arthritis Rheum 2001;44(6):1237–47.

    Article  PubMed  CAS  Google Scholar 

  38. Conaghan PG, Felson D, Gold G, Lohmander S, Totterman S, Altman R. MRI and non-cartilaginous structures in knee osteoarthritis. Osteoarthritis Cartilage 2006;14 Suppl A:A87–94.

    Article  PubMed  Google Scholar 

  39. Sandy JD, Adams ME, Billingham ME, Plaas A, Muir H. In vivo and in vitro stimulation of chondrocyte biosynthetic activity in early experimental osteoarthritis. Arthritis Rheum 1984;27(4):388–97.

    Article  PubMed  CAS  Google Scholar 

  40. Loeser RF. Molecular mechanisms of cartilage destruction: mechanics, inflammatory mediators, and aging collide. Arthritis Rheum 2006;54(5):1357–60.

    Article  PubMed  CAS  Google Scholar 

  41. Nakamura H, Masuko K, Yudoh K, Kato T, Nishioka K, Sugihara T, et al. Positron emission tomography with 18F-FDG in osteoarthritic knee. Osteoarthritis Cartilage 2007;15(6):673–81.

    Article  PubMed  CAS  Google Scholar 

  42. von Schulthess GK, Meier N, Stumpe KD. Joint accumulations of FDG in whole body PET scans. Nuklearmedizin 2001;40(6):193–7.

    Google Scholar 

  43. Omoumi P, Mercier GA, Lecouvet F, Simoni P, Vande Berg BC. CT arthrography, MR arthrography, PET, and scintigraphy in osteoarthritis. Radiol Clin North Am 2009;47(4):595–615.

    Article  PubMed  Google Scholar 

  44. Rosen RS, Fayad L, Wahl RL. Increased 18F-FDG uptake in degenerative disease of the spine: characterization with 18F-FDG PET/CT. J Nucl Med 2006;47(8):1274–80.

    PubMed  CAS  Google Scholar 

  45. Wandler E, Kramer EL, Sherman O, Babb J, Scarola J, Rafii M. Diffuse FDG shoulder uptake on PET is associated with clinical findings of osteoarthritis. AJR Am J Roentgenol 2005;185(3):797–803.

    PubMed  Google Scholar 

  46. Nakamura J, Yamada K, Mitsugi N, Saito T. A case of SAPHO syndrome with destructive spondylodiscitis suspicious of tuberculous spondylitis. Mod Rheumatol 2010;20(1):93–7.

    Article  PubMed  Google Scholar 

  47. Parsons MD, Torigian, Alavi A. Metabolic activity in the painful knee joint as measured on FDG-PET. Society of Nuclear Medicine Annual Meeting Abstracts, 2008. 49(MeetingAbstracts_1): p. 270P-a.

  48. Mathur T, Manadan AM, Hota B, Block JA. Pseudo-septic hip arthritis as the presenting symptom of ankylosing spondylitis: a case series and review of the literature. Clin Exp Rheumatol 2010;28(3):416–8.

    PubMed  Google Scholar 

  49. Wendling D, Blagosklonov O, Streit G, Lehuédé G, Toussirot E, Cardot JC. FDG-PET/CT scan of inflammatory spondylodiscitis lesions in ankylosing spondylitis, and short term evolution during anti-tumour necrosis factor treatment. Ann Rheum Dis 2005;64(11):1663–5.

    Article  PubMed  CAS  Google Scholar 

  50. Dannecker GE, Quartier P. Juvenile idiopathic arthritis: classification, clinical presentation and current treatments. Horm Res 2009;72 Suppl 1:4–12.

    Article  PubMed  CAS  Google Scholar 

  51. Tateishi U, Imagawa T, Kanezawa N, Okabe T, Shizukuishi K, Inoue T, et al. PET assessment of disease activity in children with juvenile idiopathic arthritis. Pediatr Radiol 2010;40(11):1781–8.

    Article  PubMed  Google Scholar 

  52. Blockmans D, De Ceuninck L, Vanderschueren S, Knockaert D, Mortelmans L, Bobbaers H. Repetitive 18-fluorodeoxyglucose positron emission tomography in isolated polymyalgia rheumatica: a prospective study in 35 patients. Rheumatology (Oxford) 2007;46(4):672–7.

    Article  CAS  Google Scholar 

  53. Toriihara A, Seto Y, Yoshida K, Umehara I, Nakagawa T, Liu R, et al. F-18 FDG PET/CT of polymyalgia rheumatica. Clin Nucl Med 2009;34(5):305–6.

    Article  PubMed  Google Scholar 

  54. Blockmans D, Stroobants S, Maes A, Mortelmans L. Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med 2000;108(3):246–9.

    Article  PubMed  CAS  Google Scholar 

  55. Pichler R, Weiglein K, Schmekal B, Sfetsos K, Maschek W. Bone scintigraphy using Tc-99m DPD and F18-FDG in a patient with SAPHO syndrome. Scand J Rheumatol 2003;32(1):58–60.

    Article  PubMed  Google Scholar 

  56. Yun M, Kim W, Adam LE, Alnafisi N, Herman C, Alavi A. F-18 FDG uptake in a patient with psoriatic arthritis: imaging correlation with patient symptoms. Clin Nucl Med 2001;26(8):692–3.

    Article  PubMed  CAS  Google Scholar 

  57. Popovich T, Carpenter JS, Rai AT, Carson LV, Williams HJ, Marano GD. Spinal cord compression by tophaceous gout with fluorodeoxyglucose-positron-emission tomographic/MR fusion imaging. AJNR Am J Neuroradiol 2006;27(6):1201–3.

    PubMed  CAS  Google Scholar 

  58. Hsieh MS, Wang KT, Tseng SH, Lee CJ, chen CH, Wang CC. Using (18)F-FDG microPET imaging to measure the inhibitory effects of Clematis chinensis Osbeck on the pro-inflammatory and degradative mediators associated with inflammatory arthritis. J Ethnopharmacol 2010. [Epub ahead of print].

  59. Nguyen BD, Roarke MC. F-18 FDG PET/CT incidental finding of large ischiogluteal bursitis. Clin Nucl Med 2007;32(7):535–7.

    Article  PubMed  Google Scholar 

  60. Vogel WV, van Riel PL, Oyen WJ. FDG-PET/CT can visualise the extent of inflammation in rheumatoid arthritis of the tarsus. Eur J Nucl Med Mol Imaging 2007;34(3):439.

    Article  PubMed  Google Scholar 

  61. El-Haddad G, Kumar R, Pamplona R, Alavi A. PET/MRI depicts the exact location of meniscal tear associated with synovitis. Eur J Nucl Med Mol Imaging 2006;33(4):507–8.

    Article  PubMed  Google Scholar 

  62. Kirino Y, Ihata A, Shizukuishi K, Hama M, Takase K, Suda A, et al. Multiple extra-articular synovial cysts complicated with rheumatoid arthritis. Mod Rheumatol 2009;19(5):563–6.

    Article  PubMed  Google Scholar 

  63. Fischer DR, Maquierira GJ, Espinosa N, Zanetti M, Hesselmann R, Johayem A, et al. Therapeutic impact of [(18)F]fluoride positron-emission tomography/computed tomography on patients with unclear foot pain. Skeletal Radiol 2010;39(10):987–97.

    Article  PubMed  Google Scholar 

  64. Huang SS, Yu JQ, Chamroonrat W, Alavi A, Zhuang H. Achilles tendonitis detected by FDG-PET. Clin Nucl Med 2006;31(3):147–8.

    Article  PubMed  Google Scholar 

  65. Houseni M, Chamroonrat W, Zhuang H, Alavi A. Facet joint arthropathy demonstrated on FDG-PET. Clin Nucl Med 2006;31(7):418–9.

    Article  PubMed  Google Scholar 

  66. Gaál J, Mézes A, Siró B, Varga J, Galuska L, Jánoky G, et al. 99m Tc-HMPAO labelled leukocyte scintigraphy in patients with rheumatoid arthritis: a comparison with disease activity. Nucl Med Commun 2002;23(1):39–46.

    Article  PubMed  Google Scholar 

  67. Barrera P, van der Laken CJ, Boerman OC, Oyen WJ, van de Ven MT, van Lent PL, et al. Radiolabelled interleukin-1 receptor antagonist for detection of synovitis in patients with rheumatoid arthritis. Rheumatology (Oxford) 2000;39(8):870–4.

    Article  CAS  Google Scholar 

  68. Zinn KR, Chaudhuri TR, Smyth CA, Wu Q, Liu HG, Fleck M, et al. Specific targeting of activated endothelium in rat adjuvant arthritis with a 99mTc-radiolabeled E-selectin-binding peptide. Arthritis Rheum 1999;42(4):641–9.

    Article  PubMed  CAS  Google Scholar 

  69. Kropholler MA, Boellaard R, Elzinga EH, van der Laken CJ, Maruyama K, Kloet RW, et al. Quantification of (R)-[11C]PK11195 binding in rheumatoid arthritis. Eur J Nucl Med Mol Imaging 2009;36(4):624–31.

    Article  PubMed  CAS  Google Scholar 

  70. De Schrijver M, Streule K, Senekowitsch R, Fridrich R. Scintigraphy of inflammation with nanometer-sized colloidal tracers. Nucl Med Commun 1987;8(11):895–908.

    Article  PubMed  Google Scholar 

  71. Mieras G. Professor Jack Pearce, biographical note. Br Poult Sci 2002;43 5 Suppl:641–2.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Kathleen Carey, Babak Saboury, Sandip Basu, Alex Brothers, Alexis Ogdie, Tom Werner, Drew A. Torigian & Abass Alavi

  2. Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Abass Alavi

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  1. Kathleen Carey
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Correspondence to Abass Alavi.

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Kathleen Carey and Babak Saboury contributed equally to this study.

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Carey, K., Saboury, B., Basu, S. et al. Evolving role of FDG PET imaging in assessing joint disorders: a systematic review. Eur J Nucl Med Mol Imaging 38, 1939–1955 (2011). https://doi.org/10.1007/s00259-011-1863-4

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