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Multicenter Study
. 2019 Dec;29(12):6708-6716.
doi: 10.1007/s00330-019-06302-9. Epub 2019 Jun 27.

Clinical value of a [18F]-FDG PET-CT muscle-to-muscle SUV ratio for the diagnosis of active dermatomyositis

Nihal Martis  1 , Philippe Viau  2 , Thierry Zenone  3 , Fanny Andry  4 , Aurélie Grados  5 , Mikael Ebbo  5 , Emeline Castela  6 , Benoit Brihaye  7 , Eric Denis  8 , Stéphane Liguori  9 , Alexandra Audemard  10 , Yoland Schoindre  11 , Anne-Sophie Morin  12 , Benjamin Terrier  13 , Laurent Marcq  8 , Nicolas Mounier  14 , Olivier Lidove  15 , Jean-Philippe Chaborel  16 , Denis Quinsat  8
Affiliations
Multicenter Study

Clinical value of a [18F]-FDG PET-CT muscle-to-muscle SUV ratio for the diagnosis of active dermatomyositis

Nihal Martis et al. Eur Radiol. 2019 Dec.

Abstract

Objective: To study a muscle-to-muscle standardised uptake value (SUV) ratio with FDG-PET/CT (FDG-PET) as a marker for the detection of disease activity in dermatomyositis (DM).

Methods: Patients with DM (n = 24) who met the European Neuro-Muscular Centre diagnostic criteria were retrospectively identified over a 3-year period through a national survey. Muscle biopsy was performed in all patients. Maximum SUV was measured in proximal muscles (SUVPROX) that had the highest radiotracer uptake on visual grading as well as in the musculus longissimus thoracis (SUVMLT), whereas mean SUV was measured for the liver (SUVLIV). Muscle-to-liver SUV ratios for either muscle group were compared and a SUVPROX/SUVMLT ratio was calculated. SUVPROX/SUVMLT of DM patients were compared with age- and sex-matched control subjects (n = 24) with melanoma who had received FDG-PET scans.

Results: DM patients presented with proximal and symmetrical muscle uptake. Differences in SUVPROX/SUVLIV and SUVMLT/SUVLIV ratios in DM subjects were significant (p < 0.001). SUVPROX/SUVMLT ratios in DM and their controls also differed significantly (p = 0.0012). The SUVPROX/SUVMLT ratio threshold between DM subjects and controls was 1.73 with a sensitivity of 50% (CI95%, 29.1 to 70.9%) and specificity at 83.3% (CI95%, 62.6 to 95.3%). When amyopathic DM patients were removed from the analysis, specificity was increased to 95% (CI95%, 75.1 to 99.9%) with a likelihood ratio of 10 and an AUC of 83.4% (CI95%, 71.4 to 95.4%).

Conclusion: A muscle-to-muscle SUVPROX/SUVMLT ratio with a cut-off value of 1.73 in FDG-PET imaging might serve as a non-invasive marker to determine disease activity in dermatomyositis.

Key points: • [18F]-FDG PET-scanner standardised uptake value (SUV) could reflect disease activity in dermatomyositis (DM). • A ratio of SUV in proximal muscles (SUVPROX) to SUV in musculus longissimus thoracis (SUVMLT) could be used to determine active DM. • Active disease is suspected for SUV PROX /SUV MLT ratios greater than 1.73.

Keywords: Amyopathic dermatomyositis; Dermatomyositis; Fluorodeoxyglucose F18; Myositis; Positron-emission tomography.

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