Disease activity and response to therapy monitored by [18F]FDG PET/CT using volume-based indices in IgG4-related disease

Katsuya Mitamura; Hanae Arai-Okuda; Yuka Yamamoto; Takashi Norikane; Yasukage Takami; Kengo Fujimoto; Risa Wakiya; Hiroki Ozaki; Hiroaki Dobashi; Yoshihiro Nishiyama

doi:10.1186/s13550-020-00743-w

Disease activity and response to therapy monitored by [¹⁸F]FDG PET/CT using volume-based indices in IgG4-related disease

EJNMMI Res. 2020 Dec 9;10(1):153. doi: 10.1186/s13550-020-00743-w.

Affiliations

¹ Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
² Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan. yuka@med.kagawa-u.ac.jp.
³ Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan.

Abstract

Purpose: The 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).

Methods: 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.

Results: The 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.

Keywords: IgG4-related disease; PET; [18F]FDG.