Abstract
BackgroundTo investigate the potential utility of quantitative parameters obtained by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the assessment of disease severity and the occurrence of macrophage activation syndrome (MAS) in adult-onset Still’s disease (AOSD).MethodsFifty-seven patients with AOSD who underwent pre-treatment 18F-FDG PET/CT were recruited in this study and compared with 60 age- and sex-matched healthy controls. Clinical features and laboratory data were recorded. The systemic score was assessed to determine the disease severity. The maximal standardized uptake value (SUVmax), metabolic lesion volume (MLV), and total lesion glycolysis (TLG) were used to evaluate the involved organs and tissues that abnormally accumulated 18F-FDG. Multivariate analysis was performed to identify the PET/CT-derived risk factors contributing to the AOSD-related MAS, and their diagnostic efficiency was evaluated.ResultsHigh 18F-FDG accumulation was observed in the bone marrow (SUVmax median, 5.10), spleen (SUVmax median, 3.70), and lymph nodes (LNs, SUVmax median, 5.55). The SUVmax of the bone marrow (rho = 0.376, p = 0.004), SUVmax of the spleen (rho = 0.450, p < 0.001), TLGtotal of LNs (rho = 0.386, p = 0.017), and MLVtotal of LNs (rho = 0.391, p = 0.015) were correlated with the systemic score. The SUVmax of the spleen (p = 0.017), TLGtotal of LNs (p = 0.045), and MLVtotal of LNs (p = 0.012) were higher in patients with MAS than in those without MAS. A MLVtotal of LNs > 62.2 (OR 27.375, p = 0.042) was an independent predictive factor for MAS with a sensitivity of 80.0% and a specificity of 93.9%.ConclusionsThe glucose metabolic level of the spleen could be an effective and easy-to-use imaging indicator of disease severity, and MLVtotal of LNs > 62.2 was a strong predictor of MAS occurrence in patients with AOSD.
Highlights
Adult-onset Still’s disease (AOSD) is a systemic inflammatory disease characterized by spiking fever, salmon-pink evanescent rash, arthralgia, and hepatosplenomegaly [1]
Characterization of abnormal 18F-FDG accumulation in patients with adult-onset Still’s disease (AOSD) The accumulation of 18F-FDG was significantly higher in the bone marrow, spleen, and lymph nodes (LNs) in patients with AOSD than healthy controls, except for 18F-FDG uptake in the liver (p = 0.672) (Table 2)
We further explored the utility of 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (PET/Computer tomography (CT)) to assess disease severity and macrophage activation syndrome (MAS) occurrence of AOSD
Summary
Adult-onset Still’s disease (AOSD) is a systemic inflammatory disease characterized by spiking fever, salmon-pink evanescent rash, arthralgia, and hepatosplenomegaly [1]. 18F-fluorodesoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), which reflects both the glucose metabolic activity and the anatomical structure of target tissues, is commonly used on cancer diagnosis, staging, and prognosis, assessment of treatment response [10]. The correlations between abnormal glucose metabolism of involved organs, as determined by the maximal standardized uptake value (SUVmax), and disease severity are still illusive. To investigate the potential utility of quantitative parameters obtained by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the assessment of disease severity and the occurrence of macrophage activation syndrome (MAS) in adult-onset Still’s disease (AOSD). The maximal standardized uptake value (SUVmax), metabolic lesion volume (MLV), and total lesion glycolysis (TLG) were used to evaluate the involved organs and tissues that abnormally accumulated 18F-FDG.
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