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FDG PET/CT used in identifying adult-onset Still’s disease in connective tissue diseases

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Abstract

Purpose

To explore the 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging characteristics of adult-onset Still’s disease (AOSD) and its significance in differential diagnosis from other connective tissue diseases (CTDs).

Methods

FDG PET/CT images of 54 patients with AOSD and 66 with other CTD from patients suffering from fever of unknown origin (FUO) were retrospectively studied and compared with 40 healthy controls. Clinical and PET/CT characteristics of AOSD and other CTDs were compared, and SUVmax (maximum standardized uptake value) was used to analyze the differences of FDG uptake in the blood pool, liver, spleen, bone marrow, and hyperplastic lymph nodes between the AOSD and other CTDs. The SUVmax ratios of the spleen, bone marrow, and lymph nodes to the liver were used to establish the diagnostic criteria for differential diagnosis of AOSD, and its diagnostic efficiency was evaluated.

Results

Positive findings are presented in 53/54 (98.1%) AOSD patients and 61/66 (92.4%) other CTD patients in PET/CT imaging. AOSD manifested as diffusely increased FDG uptake in the spleen and bone marrow, and multiple reactive hyperplasia lymph nodes are symmetrically distributed mainly in the neck and axilla, while other organs were seldom involved. Although these abnormalities could be seen in other CTDs, its incidence and uptake value were both higher in AOSD. If two or more of the following three standard were met, the sensitivity, specificity, and accuracy of diagnosing AOSD could reach 90.7%, 92.4%, and 91.7%, respectively: ① spleen SUVmax/liver SUVmax ≥ 1.2 and/or bone marrow SUVmax/liver SUVmax ≥ 1.4; ②symmetrically distributed reactive hyperplastic lymph nodes mainly in the neck and axilla with a lymph node SUVmax/liver SUVmax ≥ 1.8; and ③ no other abnormal uptake found in other organs.

Conclusion

Characteristic manifestations in AOSD were found on FDG PET/CT. These findings could help to identify AOSD from the other CTDs, especially in cases of fever of unknown origin, where it can assist in identifying the cause.

Key Points

• Image characteristics of FDG PET/CT in adult-onset Still’s disease were described.

• FDG PET/CT helps in identifying adult-onset Still’s disease from the other connective tissue diseases.

• FDG PET/CT imaging standard for diagnosing adult-onset Still’s disease were established.

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Author notes

  1. Xin Zhou and Yuan Li contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Peking University People’s Hospital, No.11 Xizhimen South Avenue, Xicheng District, Beijing, 100044, China

    Xin Zhou, Yuan Li & Qian Wang

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  1. Xin Zhou
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  2. Yuan Li
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Correspondence to Qian Wang.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent does not apply as this is a review manuscript.

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Zhou, X., Li, Y. & Wang, Q. FDG PET/CT used in identifying adult-onset Still’s disease in connective tissue diseases. Clin Rheumatol 39, 2735–2742 (2020). https://doi.org/10.1007/s10067-020-05041-3

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