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Baseline increased 18F-fluoride uptake lesions at vertebral corners on positron emission tomography predict new syndesmophyte development in ankylosing spondylitis: a 2-year longitudinal study

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Abstract

The goal of this study was to demonstrate whether increased 18F-fluoride uptake lesions on positron emission tomography (PET) scan can predict new syndesmophyte development in patients with ankylosing spondylitis (AS). In 12 AS patients, 18F-fluoride PET and magnetic resonance imaging (MRI) was performed at baseline, and radiography was performed at baseline and the 2-year follow-up. The following data were recorded: the presence of increased 18F-fluoride uptake lesions on PET defined as an uptake greater than the uptake in the adjacent normal vertebral body; acute (type A) and advanced (type B) corner inflammatory lesions (CILs) and fat lesions on MRI; and syndesmophytes on radiography. Of 231 anterior vertebral corners without syndesmophyte at baseline, 13 type A CILs (5.5%), 2 type B CILs (0.9%), and 20 fat lesions (8.7%) on MRI and six increased fluoride uptake lesions (2.6%) on PET were observed. At the 2-year follow-up, 16 new syndesmophytes (6.9%) in eight AS patients (66.7%) occurred. New syndesmophytes developed significantly more frequently in anterior vertebral corners with increased 18F-fluoride uptake lesions (50%) or fat lesions (25%) at baseline than in those without such lesions (5.8 and 5.2%; p = 0.005 and p = 0.007, respectively). After adjusting confounding factors, baseline increased 18F-fluoride uptake lesions was independently associated with new syndesmophytes development (OR 13.8, 95% CI 1.5–124.3, p = 0.019). Fat lesions were also associated with new syndesmophytes formation. Our data suggest that 18F-fluoride PET may be applied to identify AS patients with high risk of future syndesmophyte formation.

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Acknowledgements

We specially thank the late Professor Sung-Il Kim who devoted himself to education, research, and patient care in the Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine (1963–2011).

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This work was supported by clinical research grant from Pusan National University Hospital 2016.

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    Authors and Affiliations

    1. Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea

      Eun-Kyoung Park, Ji-Heh Park & Seung-Geun Lee

    2. Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea

      Kyoungjune Pak, Keunyoung Kim & In-Joo Kim

    3. Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea

      Seong-Jang Kim

    4. Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea

      Geun-Tae Kim

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    Eun-Kyoung Park and Kyoungjune Pak have equally contributed on this work.

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    Park, EK., Pak, K., Park, JH. et al. Baseline increased 18F-fluoride uptake lesions at vertebral corners on positron emission tomography predict new syndesmophyte development in ankylosing spondylitis: a 2-year longitudinal study. Rheumatol Int 37, 765–773 (2017). https://doi.org/10.1007/s00296-017-3660-2

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