Abstract
PurposeThe efficiency of [18F]FDG PET/CT using volume-based indices was evaluated to assess the disease activity and response to therapy in patients with immunoglobulin G4-related disease (IgG4-RD).MethodsA total of 17 patients with IgG4-RD were examined with [18F]FDG PET/CT before and during treatment. The lesion boundary was determined using a fixed threshold of standardized uptake value (SUV) ≥ 2.5. The highest maximum SUV (SUVmax) among all affected lesions was calculated for individual patients. We summed metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of each affected lesion to generate a total MTV and total TLG. PET results were compared with those of serum IgG4 and soluble interleukin-2 receptor (sIL-2R) levels.ResultsThe mean number of involved organs per patient was 3.8 as determined by [18F]FDG uptake. The number of involved organs, total MTV and total TLG were significantly correlated with IgG4 (P = 0.046, < 0.001, < 0.001, respectively) and sIL-2R (P < 0.001, = 0.031, 0.031, respectively). According to the clinical assessments for therapy response, all patients were classified as improved. The SUVmax, total MTV, and total TLG during therapy were all significantly lower than those before therapy (all P < 0.001).Conclusion[18F]FDG PET/CT is valuable for assessing the extent of multi-organ involvement before therapy and monitoring subsequent therapy in patients with IgG4-RD. [18F]FDG PET/CT using volumetric indices correlated with serum IgG4 and sIL-2R levels.
Highlights
Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibro-inflammatory condition characterized by diffuse or focal organ enlargement containing mass-forming lesions with copious IgG4-positive plasma cells [1, 2]
Volume-based indices such as the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are useful in assessing disease activity [14]. Their advantage is to reflect the activity of the glucose metabolism in the entire lesion, whereas the SUVmax reflects that of only a single voxel
The number of involved organs, total MTV and total TLG showed a significant correlation with IgG4 (P = 0.046, < 0.001, < 0.001, respectively) and soluble interleukin-2 receptor (sIL-2R) (P < 0.001, = 0.031, 0.031, respectively)
Summary
A total of 17 patients with IgG4-RD were examined with [18F]FDG PET/CT before and during treatment. The lesion boundary was determined using a fixed threshold of standardized uptake value (SUV) ≥ 2.5. The highest maximum SUV (SUVmax) among all affected lesions was calculated for individual patients. We summed metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of each affected lesion to generate a total MTV and total TLG. PET results were compared with those of serum IgG4 and soluble interleukin-2 receptor (sIL-2R) levels
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