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Whole-body FDG-PET/CT on rheumatoid arthritis of large joints

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Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

Fluorodeoxyglucose (FDG) uptake in joint lesions in patients with rheumatoid arthritis (RA) reportedly represents the degree of synovial inflammation. Most previous studies have focused on small joints, and the application of whole-body positron emission tomography (PET) combined with computed tomography (CT) (PET/CT) for the evaluation of inflammatory activity in large joints has not been well studied.

Methods

Eighteen patients with RA underwent FDG-PET/CT. FDG uptake in the knee, hip, carpal, wrist, elbow, shoulder, and atlanto-axial joint (total of 13 joints) and in the axillary lymph nodes was evaluated by calculating the maximum standardized uptake value (SUVmax) and the visual uptake scores as follows: 0, no uptake; 1, slight uptake; 2, moderate uptake (same as in liver); 3, higher than in liver; 4, highest uptake. The number of painful/swollen joints, the white blood cell (WBC) count, and the C-reactive protein (CRP) level were also evaluated.

Results

Whole-body FDG-PET/CT delineated large-joint lesions in patients with RA, and the metabolic activity of inflammation was accurately overlaid on the joint anatomy. The total FDG score for all 13 joints was significantly correlated with the CRP level (r = 0.653, p < 0.01, n = 18). The total SUVmax and the CRP level were weakly, but not significantly, correlated (r = 0.377, p > 0.05). The WBC count was not correlated with any other parameter. The mean number of joints per patient with an FDG uptake score of 2 or more was significantly larger than the mean number of painful/swollen joints (6.2 ± 3.3 vs. 3.1 ± 2.7, n = 18, p < 0.01) and both parameters were strongly correlated (r = 0.588, p < 0.01, n = 18). Also, FDG uptake score and SUV of painful/swollen joints were significantly higher than these of not painful/swollen joints. FDG uptake was significantly different from patients of remission and patients of active arthritis. Uptake in the atlanto-axial joint was observed in five (mostly asymptomatic) patients (5/18, 28%), and the uptake score was significantly correlated with the total FDG score (r = 0.669, p < 0.01, n = 18). The axillary lymph nodes score was correlated with the arm joints score.

Conclusion

FDG-PET/CT represents the inflammatory activity in large joints in patients with RA accurately and sensitively and may be helpful for early evaluations of the extent of RA throughout the whole body including high risk lesion of atlanto-axial joint. Furthermore, the visual FDG uptake score may be useful for evaluating arthritis in large joints.

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Acknowledgments

We would like to thank Kazuhiko Nakajima, M.Sc., Yasuhiro Kashimura, BS, and Akio Ishibashi, BS, for their excellent technical assistance. Part of this study was supported by a Grant-in-aid for cancer research (No. 17-12) from the Ministry of Health, Labor and Welfare and by a Grant for International Health Research (21A126) from the Ministry of Health, Labor and Welfare.

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Authors and Affiliations

  1. Department of Radiology, Division of Nuclear Medicine, International Medical Center of Japan Toyama Hospital, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Kazuo Kubota, Miyako Morooka, Takuya Mitsumoto & Kyoko Kurihara

  2. Department of Internal Medicine, Division of Collagen Diseases, International Medical Center of Japan Toyama Hospital, Tokyo, Japan

    Hiroyuki Yamashita, Yuko Takahashi & Akio Mimori

  3. Department of Nuclear Medicine, Saitama Medical University, International Medical Center, Saitama, Japan

    Kimiteru Ito

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  1. Kazuo Kubota
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  2. Kimiteru Ito
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Correspondence to Kazuo Kubota.

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Kubota, K., Ito, K., Morooka, M. et al. Whole-body FDG-PET/CT on rheumatoid arthritis of large joints. Ann Nucl Med 23, 783–791 (2009). https://doi.org/10.1007/s12149-009-0305-x

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  • DOI: https://doi.org/10.1007/s12149-009-0305-x

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