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18F-FDG PET/CT and HRCT: a combined tool for risk stratification in idiopathic inflammatory myopathy-associated interstitial lung disease

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Abstract

Objectives

Rapidly progressive interstitial lung disease (RP-ILD) is a life-threatening form of idiopathic inflammatory myopathy (IIM)-associated interstitial lung disease (ILD). We aimed to assess the combination of 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and high-resolution computed tomography (HRCT) for the quantification of IIM-ILD activity and risk stratification for RP-ILD.

Method

Patients with IIM and undergoing 18F-FDG PET/CT were included in this retrospective study. Pulmonary FDG uptake was assessed using the maximum standardized uptake value (SUVlung) and visual score (PET score). HRCT was evaluated using visual analysis (HRCT score). Multivariable logistic regression was used to identify risk factors for RP-ILD.

Results

Seventy-three patients with IIM (17 with RP-ILD, 38 with non-RP-ILD, and 18 without ILD) were included. SUVlung, PET score, and HRCT score were significantly higher in RP-ILD than in non-RP-ILD. Strong positive correlations were observed between SUVlung, PET score, and the HRCT parameters. The area under the curve (AUC) of the PET score to differentiate between RP-ILD and non-RP-ILD (AUC = 0.860) was higher than that of the SUVlung (AUC = 0.802) and HRCT scores (AUC = 0.806). We developed a risk score based on the number of positive risk factors (PET score > 18, HRCT score > 140, and positive anti-melanoma differentiation-associated gene 5 (MDA5) antibody) to differentiate between RP-ILD and non-RP-ILD (AUC = 0.955). Patients with higher risk scores had significantly worse prognoses.

Conclusions

18F-FDG PET/CT is useful for assessing disease activity in patients with IIM-ILD. The combination of PET score, HRCT score, and anti-MDA5 antibody can be used to identify patients at increased risk of RP-ILD and with poor prognoses.

Key Points

• 18 F-FDG PET/CT helps to assess the inflammatory burden in patients with IIM-ILD.

• Whole-lung FDG uptake assessment (PET score) showed superior performance in discriminating RP-ILD and non-RP-ILD compared with SUV lung and HRCT visual analysis.

• The combination of PET score, HRCT score, and anti-MDA5 antibody can identify patients at increased risk of RP-ILD and with poor prognoses.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Chang Yi, Xincong Shi, Ganhua Luo, Zhaorong Lu, Fuhua Wen, Dake Zhang, and Renbo Wu for technical assistance.

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Author notes

  1. Yuying Zhang and Zhifeng Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Er Road, 510080, Guangzhou, China

    Yuying Zhang, Zhifeng Chen, Yali Long, Bing Zhang, Qiao He & Xiangsong Zhang

  2. Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China

    Kejing Tang

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Contributions

Xiangsong Zhang and Kejing Tang contributed to the conception and design of the study; Yuying Zhang, Bing Zhang, Qiao He, and Yali Long contributed to data collection and analysis. Zhifeng Chen and Xiangsong Zhang performed image interpretation and analysis. Yuying Zhang drafted the manuscript. Zhifeng Chen and Xiangsong Zhang revised the manuscript critically. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiangsong Zhang.

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The study protocol was approved by the Ethics Committee of FAHSYSU and was conducted in accordance with the principles of the Declaration of Helsinki.

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Written informed consent was obtained from all patients. For deceased patients, informed consent was obtained from their relatives.

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Zhang, Y., Chen, Z., Long, Y. et al. 18F-FDG PET/CT and HRCT: a combined tool for risk stratification in idiopathic inflammatory myopathy-associated interstitial lung disease. Clin Rheumatol 41, 3095–3105 (2022). https://doi.org/10.1007/s10067-022-06239-3

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