Fluorodeoxyglucose positron emission tomography/computed tomography in the diagnosis, assessment of disease activity and therapeutic response in relapsing polychondritis

Abstract

Objective To evaluate 18F-fluorodeoxyglucose (FDG) PET/CT in the assessment of disease activity, extent of the disease and response to therapy in relapsing polychondritis. Methods Twenty-five patients (9 men, 16 women) with a mean age of 38.2 years (s.d. 13.7; range 18–62), diagnosed to have relapsing polychondritis according to Damiani and Levine’s modification of McAdam’s criteria, who underwent PET/CT examination were included. Ten patients underwent a second PET/CT examination after therapy or during follow-up. Clinical symptoms and auxiliary examination findings were recorded. PET/CT findings were reviewed and correlated with the clinical symptoms. Results The major symptoms were aural pain (n = 21), nasal pain (n = 10), stridor (n = 5), cough (n = 9), fever (n = 8) and laryngeal tenderness (n = 8). The initial PET/CT was positive in 23/25 patients. PET/CT revealed involvement of auricular (n = 14), nasal (n = 8), laryngeal (n = 7), tracheobronchial (n = 6) and Eustachian (n = 3) cartilages with a mean maximum standardized uptake value (SUVmax) of 4.1 (s.d. 2.5; range 1.7–12.7). Fair correlation of aural/nasal pain/stridor with FDG avidity of cartilage involvement on PET/CT was noted. The key finding was detection of asymptomatic large airway involvement in seven patients (28%). Re-examination PET in 10 patients revealed complete therapeutic response (n = 5), partial response (n = 1), stable disease (n = 1), progressive disease (n = 1) and disease recurrence (n = 2). Conclusion FDG PET/CT is a useful tool for the assessment of the disease activity and extent. It identified activity in clinically inaccessible sites that are of clinical significance. It is also useful in assessing treatment response and finding relapse.

F-18 FDG PET/CT in Relapsing Polychondritis Patients with Initial Respirotory Symptoms: Imaging Features and Association with Pulmonary Function and Disease Activity

“…In terms of assessing disease activity, our study showed that both SUV max and PETFBS changed in parallel to the clinical assessment, which was consistent with previous results [11,13,15] . Apart from imaging markers, the nonspeci c serological markers ESR and CRP are routinely used in clinical practice.…”

“…However, the majority of RP patients with airway involvement were misdiagnosed at their rst visit with a median time of delay to diagnosis of up to more than 10 years [1,4,5] . Our early studies [6][7][8] , along with other previous case reports or sporadic cases have shown that 18F-uorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT, hereafter termed PET/CT) with its semiquantitative parameter SUV max may be a helpful tool in aiding in the diagnosis and for therapeutic response monitoring [9][10][11][12][13][14][15] , with typical imaging characteristics of FDG uptake in the laryngo-tracheo-bronchial tree, often symmetrically.…”

Respiratory subtype of relapsing polychondritis frequently presents as difficult asthma: a descriptive study of respiratory involvement in relapsing polychondritis with 13 patients from a single UK centre

“…Clinical and symptomatic evaluation, dynamic (inspiratory and expiratory) CT scans and flexible bronchoscopy were critical in establishing the diagnosis of TBM which is consistent with reports from literature [8][9][10]. Other features of RP were identified clinically although recent reports suggest Positron Emission Tomography (PET CT) might be an additional resource for defining the severity and extent of disease [25].…”

Differential diagnosis of relapsing polychondritis from asthma by 18‐fluoro‐2‐deoxyglucose positron emission tomography and computed tomography

“…The clinical symptoms improved with the start of oral prednisolone therapy (20 mg/day). In conclusion, FDG‐PET/CT was useful for the differential diagnosis of relapsing polychondritis from asthma 1 …”