18F-FDG PET/CT and HRCT: a combined tool for risk stratification in idiopathic inflammatory myopathy-associated interstitial lung disease

Yuying Zhang; Zhifeng Chen; Yali Long; Bing Zhang; Qiao He; Kejing Tang; Xiangsong Zhang

doi:10.1007/s10067-022-06239-3

18F-FDG PET/CT and HRCT: a combined tool for risk stratification in idiopathic inflammatory myopathy-associated interstitial lung disease

Clin Rheumatol. 2022 Oct;41(10):3095-3105. doi: 10.1007/s10067-022-06239-3. Epub 2022 Jun 27.

Authors

Yuying Zhang¹, Zhifeng Chen¹, Yali Long¹, Bing Zhang¹, Qiao He¹, Kejing Tang², Xiangsong Zhang³

Affiliations

¹ Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Er Road, 510080, Guangzhou, China.
² Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China.
³ Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Er Road, 510080, Guangzhou, China. zhxiangs@mail.sysu.edu.cn.

PMID: 35759126
DOI: 10.1007/s10067-022-06239-3

Abstract

Objectives: Rapidly progressive interstitial lung disease (RP-ILD) is a life-threatening form of idiopathic inflammatory myopathy (IIM)-associated interstitial lung disease (ILD). We aimed to assess the combination of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and high-resolution computed tomography (HRCT) for the quantification of IIM-ILD activity and risk stratification for RP-ILD.

Method: Patients with IIM and undergoing ¹⁸F-FDG PET/CT were included in this retrospective study. Pulmonary FDG uptake was assessed using the maximum standardized uptake value (SUV_lung) and visual score (PET score). HRCT was evaluated using visual analysis (HRCT score). Multivariable logistic regression was used to identify risk factors for RP-ILD.

Results: Seventy-three patients with IIM (17 with RP-ILD, 38 with non-RP-ILD, and 18 without ILD) were included. SUV_lung, PET score, and HRCT score were significantly higher in RP-ILD than in non-RP-ILD. Strong positive correlations were observed between SUV_lung, PET score, and the HRCT parameters. The area under the curve (AUC) of the PET score to differentiate between RP-ILD and non-RP-ILD (AUC = 0.860) was higher than that of the SUV_lung (AUC = 0.802) and HRCT scores (AUC = 0.806). We developed a risk score based on the number of positive risk factors (PET score > 18, HRCT score > 140, and positive anti-melanoma differentiation-associated gene 5 (MDA5) antibody) to differentiate between RP-ILD and non-RP-ILD (AUC = 0.955). Patients with higher risk scores had significantly worse prognoses.

Conclusions: ¹⁸F-FDG PET/CT is useful for assessing disease activity in patients with IIM-ILD. The combination of PET score, HRCT score, and anti-MDA5 antibody can be used to identify patients at increased risk of RP-ILD and with poor prognoses.

Keywords: Anti-MDA5 antibody; High-resolution computed tomography; Interstitial lung disease; Myositis; Positron emission tomography.

MeSH terms

Fluorodeoxyglucose F18
Humans
Lung Diseases, Interstitial* / complications
Lung Diseases, Interstitial* / diagnostic imaging
Myositis* / complications
Myositis* / diagnostic imaging
Positron Emission Tomography Computed Tomography / adverse effects
Positron Emission Tomography Computed Tomography / methods
Retrospective Studies
Risk Assessment

Substances

Fluorodeoxyglucose F18