Characteristics and Clinical Value of 18F-FDG PET/CT in the Management of Adult-Onset Still’s Disease: 35 Cases

Abstract

While the diagnosis of adult-onset Still’s disease (AOSD) involves the exclusion of differential diagnoses, the characteristics and value of 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography coupled with CT (PET/CT) in the management of AOSD remain poorly known. Our retrospective study included patients from four centers, fulfilling Yamaguchi or Fautrel criteria, who underwent a PET/CT during an active AOSD. Thirty-five patients were included. At the time of PET/CT, the Yamaguchi criteria were met in 23 of 29 evaluable cases. PET/CT showed bone marrow (74.3%), lymph node (74.3%), and splenic (48.6%) FDG uptake. Despite arthralgia or arthritis in most patients, joints were rarely the sites of 18F-FDG accumulation. The spatial distribution of 18F-FDG uptake was nonspecific, and its intensity could be similar to malignant disease. Lymph node or bone marrow biopsy was performed after PET/CT in 20 patients (57.1%). The intensity of bone marrow; splenic and lymph node hypermetabolism appeared to be correlated with disease activity. Abnormal PET/CT in the cervical lymph nodes and age ≥ 60 years seemed to be predictive factors for monocyclic evolution. The clinical value of PET/CT is not in direct diagnosis; but as an aid in excluding differential diagnoses by searching for their scintigraphic features and guiding biopsy.

Optimal use of the FDG-PET/CT in the diagnostic process of fever of unknown origin (FUO): a comprehensive review

“…The typical FDG-PET/CT findings in AOSD are uptake in bone marrow, lymph nodes, and spleen, and the intensity of FDG uptake is correlated with disease activity [ 96 ]. The differential diagnosis for AOSD includes infectious disease, malignant disease, and systemic disease [ 97 ], and lymphoma and viral infections that can cause FUO show a similar pattern of FDG uptake as for AOSD. The pathological findings of AOSD in lymph nodes are lymphadenitis or lymphatic hyperplasia to varying degrees.…”

Strategy and Challenges of Paraclinical Examinations in Adult-Onset Still’s Disease

“…PET/CT is not systematically performed but may be discussed in some cases [33]. It should be noted, however, that even in cases of proven Still's disease, PET/CT showed FDG uptake in bone marrow and lymph nodes in three out of four cases, and in the spleen in one out of two cases [35]. Sometimes the conclusion of the examination is in favor of a malignant origin because the spatial distribution of 18F-FDG uptake and its intensity can be similar to a malignant disease.…”

“…The glucose metabolism of the liver, spleen, and bone marrow of AOSD patients have been correlated with inflammatory markers, suggesting that it could be applied to evaluate disease activity [36]. More interestingly, the prognosis could also be clarified by PET with a link between intense 18F-FDG uptake and monocyclic forms of the disease [35].…”