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. 2021 Jul 23;23(1):198.
doi: 10.1186/s13075-021-02578-9.

The lungs were on fire: a pilot study of 18F-FDG PET/CT in idiopathic-inflammatory-myopathy-related interstitial lung disease

Junyu Liang #  1 , Heng Cao #  1 , Yinuo Liu  2 , Bingjue Ye  3 , Yiduo Sun  1 , Yini Ke  1 , Ye He  1 , Bei Xu  1 , Jin Lin  4
Affiliations

The lungs were on fire: a pilot study of 18F-FDG PET/CT in idiopathic-inflammatory-myopathy-related interstitial lung disease

Junyu Liang et al. Arthritis Res Ther. .

Abstract

Background: Interstitial lung disease (ILD) and its rapid progression (RP) are the main contributors to unfavourable outcomes of patients with idiopathic inflammatory myopathy (IIM). This study aimed to identify the clinical value of PET/CT scans in IIM-ILD patients and to construct a predictive model for RP-ILD.

Methods: Adult IIM-ILD patients who were hospitalized at four divisions of the First Affiliated Hospital, Zhejiang University School of Medicine (FAHZJU), from 1 January 2017 to 31 December 2020 were reviewed. PET/CT scans and other characteristics of patients who met the inclusion and exclusion criteria were collected and analysed.

Results: A total of 61 IIM-ILD patients were enrolled in this study. Twenty-one patients (34.4%) developed RP-ILD, and 24 patients (39.3%) died during follow-up. After false discovery rate (FDR) correction, the percent-predicted diffusing capacity of the lung for carbon monoxide (DLCO%, P = 0.014), bilateral lung mean standard uptake value (SUVmean, P = 0.014) and abnormal mediastinal lymph node (P = 0.045) were significantly different between the RP-ILD and non-RP-ILD groups. The subsequent univariate and multivariate logistic regression analyses verified our findings. A "DLM" model was established by including the above three values to predict RP-ILD with a cut-off value of ≥ 2 and an area under the curve (AUC) of 0.905. Higher bilateral lung SUVmean (P = 0.019) and spleen SUVmean (P = 0.011) were observed in IIM-ILD patients who died within 3 months, and a moderate correlation was recognized between the two values.

Conclusions: Elevated bilateral lung SUVmean, abnormal mediastinal lymph nodes and decreased DLCO% were significantly associated with RP-ILD in IIM-ILD patients. The "DLM" model was valuable in predicting RP-ILD and requires further validation.

Keywords: Dermatomyositis; Idiopathic inflammatory myopathy; Interstitial lung disease; PET/CT scan; Polymyositis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Visual examination of 18F-FDG-PET/CT scan and HRCT of one IIM-ILD patients who developed RP-ILD. A to C. Prominently elevated FDG uptake in bilateral lungs of one IIM-ILD patient who later developed RP-ILD. D to F and G to I. Prominently elevated FDG uptake in bilateral lungs of one IIM-ILD patient indicated future RP-ILD in one week (where the arrow pointed). FDG: Fluorodeoxyglucose; HRCT: High resolution CT; IIM-ILD: Idiopathic-inflammatory-myopathy-related interstitial lung disease; RP-ILD: Rapidly progressive interstitial lung disease
Fig. 2
Fig. 2
Evaluation of IIM-ILD patients with or without RP-ILD. A. Survival of IIM-ILD patients with or without RP-ILD. B. Comparison of bilateral lung SUVmean in RP-ILD and non-RP-ILD groups. C. Comparison of DLCO% in RP-ILD and non-RP-ILD groups. D. ROC curve of bilateral lung SUVmean predicting RP-ILD. E. ROC curve of DLCO% predicting RP-ILD. IIM-ILD: Idiopathic-inflammatory-myopathy-related interstitial lung disease; RP-ILD: Rapidly progressive interstitial lung disease; SUVmean: mean standard uptake value; DLCO%: Percent-predicted diffusing capacity of the lung for carbon monoxide; ROC: Receiver operating characteristic; AUC: Area under the curve
Fig. 3
Fig. 3
Evaluation of DLM model in predicting RP-ILD in IIM-ILD patients. A. Distribution of RP-ILD and non-RP-ILD patients in each DLM score group. B. ROC curve of DLM model predicting RP-ILD. RP-ILD: Rapidly progressive interstitial lung disease; IIM-ILD: Idiopathic-inflammatory-myopathy-related interstitial lung disease; ROC: Receiver operating characteristic; AUC: Area under the curve
Fig. 4
Fig. 4
Evaluation of abnormal FDG uptake in IIM-ILD patients with different survival. A. Comparison of bilateral lung SUVmean in IIM-ILD patients who died within three months or survived beyond this threshold. B. Comparison of spleen SUVmean in IIM-ILD patients who died within three months or survived beyond three months. C. Correlation between bilateral lung SUVmean and spleen SUVmean in IIM-ILD patients. FDG: Fluorodeoxyglucose; IIM-ILD: Idiopathic-inflammatory-myopathy-related interstitial lung disease; SUVmean: mean standard uptake value
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