Abstract
Two cases of rheumatoid nodules evaluated by fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and video-assisted thoracic surgery (VATS) biopsy are reported. The first case was that of a 44-year-old woman who presented with a cavitated nodule with intense standardized uptake values (SUVs) both in the early (max 3.4) and delayed (max 4.4) phases, suggesting malignancy. However, after VATS biopsy, she was diagnosed as having a rheumatoid nodule with vasculitis. The second case was that of a 74-year-old woman admitted with bilateral lung nodules, two of which showed intense early (max 2.2) and delayed (max 6.0) phase SUVs, and mild early (max 0.6) and delayed (max 0.9) phase SUVs. These two nodules were finally proven to be a lung cancer and rheumatoid nodule without vasculitis, respectively. These cases show that rheumatoid nodules with an enhanced inflammatory process, such as vasculitis, can appear false-positive for malignancy on FDG-PET/CT scan images.
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References
Antin-Ozerkis D, Evans J, Rubinowitz A, Homer RJ, Matthay RA. Pulmonary manifestations of rheumatoid arthritis. Clin Chest Med. 2010;31:451–78.
Khurana R, Wolf R, Berney S, Caldito G, Hayat S, Berney SM. Risk of development of lung cancer is increased in patients with rheumatoid arthritis: a large case control study in US veterans. J Rheumatol. 2008;35:1704–8.
Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA. 2001;285:914–24.
Lowe VJ, Hoffman JM, DeLong DM, Patz EF, Coleman RE. Semiquantitative and visual analysis of FDG-PET images in pulmonary abnormalities. J Nucl Med. 1994;35:1771–6.
Bagga S. Rheumatoid lung disease as seen on PET/CT scan. Clin Nucl Med. 2007;32:753–4.
Gupta P, Ponzo F, Kramer EL. Fluorodeoxyglucose (FDG) uptake in pulmonary rheumatoid nodules. Clin Rheumatol. 2005;24:402–5.
Strobel K, von Hochstetter AR, Exner UG. FDG uptake in a rheumatoid nodule with imaging appearance similar to a malignant soft tissue tumor. Clin Nucl Med. 2009;34:691–2.
Bakheet SM, Powe J. Fluorine-18-fluorodeoxyglucose uptake in rheumatoid arthritis-associated lung disease in a patient with thyroid cancer. J Nucl Med. 1998;39:234–6.
Klein JS, Braff S. Imaging evaluation of the solitary pulmonary nodule. Clin Chest Med. 2008;29:15–38.
Katusic S, Beard CM, Kurland LT, Weis JW, Bergstralh E. Occurrence of malignant neoplasms in the Rochester, Minnesota, rheumatoid arthritis cohort. Am J Med. 1985;78:50–5.
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 10-2001. A 53-year-old woman with arthritis and pulmonary nodules. N Engl J Med. 2001;344:997–1004.
Yang Y, Fujita J, Tokuda M, Bandoh S, Ishida T. Lung cancer associated with several connective tissue diseases: with a review of literature. Rheumatol Int. 2001;21:106–11.
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Saraya, T., Tanaka, R., Fujiwara, M. et al. Fluorodeoxyglucose (FDG) uptake in pulmonary rheumatoid nodules diagnosed by video-assisted thoracic surgery lung biopsy: two case reports and a review of the literature. Mod Rheumatol 23, 393–396 (2013). https://doi.org/10.1007/s10165-012-0664-3
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DOI: https://doi.org/10.1007/s10165-012-0664-3