Intérêt de la TEP-TDM au 18F-FDG dans les rhumatismes inflammatoires notamment la pseudopolyarthrite rhizomélique : étude rétrospective de 223 examens

Abstract : Purpose. The aim of the study was the evaluation of 18F-FDG PET/CT scores to identify polymyalgia rheumatica (PMR) among other patients suffering from rheumatic diseases. Secondarily, it aimed to define PET/CT semiology of rheumatic diseases and evaluate the accuracy to diagnose large vessel vasculitis (LVV). Subjects and methods. We retrospectively included 216 patients with suspicion of rheumatic disease, unexplained biological inflammatory syndrome or suspicion of LVV, who underwent 223 PET/CT between April 2011 and December 2015 in our institution. Analysis of the images demonstrated articular and periarticular FDG uptake at different locations as well as associated vasculitis. Thus, we calculated articular uptake specificity among various diseases: PMR, spondyloarthritis (SpA), SAPHO and rheumatoid arthritis (RA) and the proportion of LVV. A semi-quantitative analysis of FDG uptake (from 0 to 3 according to liver uptake) was performed on 17 hotspots suggestive of PMR. Moreover, scores reflecting mean FDG uptake and number of sites with significant uptake (superior to liver) were assessed. For both scores, sensitivity, specificity and optimal cutoffs, determined by ROC curves, were calculated. Results. In this study, 162 PET/CT were realized in patients who suffered from inflammatory rheumatisms, 32 in patients with rheumatic diseases without inflammatory rheumatisms and 29 in patients without rheumatic diseases. Among 162 PET/CT realized in patients who had inflammatory rheumatisms, 57 were PMR (ten associated with LVV), 50 RA, 18 SpA, ten LVV, five psoriatic arthritis, five microcrystalline arthritis, four RS3PE, four paraneoplastic syndromes, three SAPHO and six unclassified rheumatisms. On visual reading, we found shoulders uptake in 73.7% of the PMR group, spinous process and hips uptake in 57.9% of the PMR group ; these results however lacked specificity, respectively 57.8%, 61.4% and 73.5%. On the contrary, sacroiliac uptake in SpA and peripheral joints uptake in RA were highly specific, respectively 97.5% and 88.6%. In this study, 55% (11/20) of LVV patients showed a significant uptake on vascular wall. Four rheumatic diseases were finally considered as paraneoplastic syndromes. Significant differences between 57 PMR PET/CT and 162 inflammatory rheumatisms PET/CT were found for mean FDG uptake score (1.32 ± 0.61 vs 0.87 ± 0.63, p < 10-7) and for the number of sites with significant uptake: 6.9 ± 4.88 sites vs 3.5 ± 4.46 sites (p < 10-7). The presence of three or more sites with significant uptake was correlated with the diagnosis of PMR with 86% sensitivity and 85.5% specificity [AUC 0,872, (IC-95% 0,81-0,93)]. To distinguish PMR without associated LVV from other diagnosis in our study, the cut-off was 0.824 (78.7% sensitivity and 75.6% specificity, [AUC 0,835, (IC-95% 0,77-0,90)] for the mean FDG uptake score. Conclusion. In addition to visual reading, uptake scores are relevant for distinguishing polymyalgia rheumatica among other patients suffering from rheumatic diseases.
Complete list of metadatas

Cited literature [42 references]  Display  Hide  Download

https://dumas.ccsd.cnrs.fr/dumas-02094977
Contributor : Santé Uca <>
Submitted on : Wednesday, April 10, 2019 - 10:20:55 AM
Last modification on : Tuesday, October 8, 2019 - 1:14:02 PM

File

Thèse_AMAT_Julie.pdf
Files produced by the author(s)

Identifiers

  • HAL Id : dumas-02094977, version 1

Collections

Citation

Julie Amat. Intérêt de la TEP-TDM au 18F-FDG dans les rhumatismes inflammatoires notamment la pseudopolyarthrite rhizomélique : étude rétrospective de 223 examens. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02094977⟩

Share

Metrics

Record views

39

Files downloads

109