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Review
. 2022 Nov 30:9:1070445.
doi: 10.3389/fmed.2022.1070445. eCollection 2022.

18F-FDG PET molecular imaging: A relevant tool to investigate chronic inflammatory rheumatisms in clinical practice?

Marie Pean De Ponfilly-Sotier  1 , Raphaële Seror  1   2   3 , Gaetane Nocturne  1   2   3 , Florent L Besson  2   4   5
Affiliations
Review

18F-FDG PET molecular imaging: A relevant tool to investigate chronic inflammatory rheumatisms in clinical practice?

Marie Pean De Ponfilly-Sotier et al. Front Med (Lausanne). .

Abstract

18F-Labeled Fluorodeoxyglucose-Positron Emission Tomography (18F-FDG PET) is a molecular imaging tool commonly used in practice for the assessment of many cancers. Thanks to its properties, its use has been progressively extended to numerous inflammatory conditions, including chronic inflammatory rheumatism (CIR) such as rheumatoid arthritis (RA), spondylarthritis (SpAs) and polymyalgia rheumatica (PMR). 18F-FDG PET is currently not recommended for the diagnostic of CIRs. However, this whole-body imaging tool has emerged in clinical practice, providing a general overview of systemic involvement occurring in CIRs. Numerous studies have highlighted the capacity of 18F-FDG PET to detect articular and extra articular involvements in RA and PMR. However, the lack of specificity of 18F-FDG limits its use for diagnosis purpose. Finally, the key question is the definition of the best way to integrate this whole-body imaging tool in the patient's management workflow.

Keywords: 18F-FDG; PET; polymyalgia rheumatica; rheumatoid arthritis; spondylarthropathy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
SpA and PMR: typical but non-specific periarticular patterns of 18F-FDG uptake at the individual whole-body level. In both SpA (A,B) and PMR (C,D), typical increase of 18F-FDG uptake is frequently observed in the scapular and pelvic girdles as illustrated here, but also at sterno-clavicular joints and interspinous processes. In both CIR, peripheric articular involvement (knees) may also be observed. Typical 18F-FDG PET findings are thus non-specific at the patient level.
FIGURE 2
FIGURE 2
18F-FDG PET of SpA. In SpA, sacro-iliitis is a highly specific pattern of 18F-FDG uptake, as illustrated here in the right sacro-iliac joint, but is rarely observed in practice. As for PMR, 18F-FDG uptake of the sterno-clavicular joints, scapular and pelvic girdles is also observed.
FIGURE 3
FIGURE 3
18F-FDG PET of PMR. In PMR, active LVV frequently overlaps, as illustrated here with the long linear and smooth 18F-FDG uptake of the right vertebral artery in this corticosteroid resistant PMR patient. As for SpA, 18F-FDG uptake of the sterno-clavicular joints, scapular, and pelvic girdles is also typically observed.
FIGURE 4
FIGURE 4
18F-FDG PET changes under treatment: typical but no current benefit over standard biomarkers. In this case of PMR, significant decrease of 18F-FDG uptake is observed in the targeted joints (here the scapular and pelvic girdles, ischial tuberosities) under treatment (A) baseline scan, and (B) after several lines of treatment). Although metabolic changes assessed with 18F-FDG are frequently observed, the clinical benefit of such imaging biomarker over standard clinical and biological biomarkers for disease monitoring remains to be defined.
See this image and copyright information in PMC

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