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

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.

[1]  Liyan Wan,et al.  Total metabolic lesion volume of lymph nodes measured by 18F-FDG PET/CT: a new predictor of macrophage activation syndrome in adult-onset Still’s disease , 2021, Arthritis Research & Therapy.

[2]  C. Campi,et al.  18F-Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography With Magnetic Resonance for Diagnosing Adult-Onset Still's Disease , 2020, Frontiers in Medicine.

[3]  Yuan Li,et al.  FDG PET/CT used in identifying adult-onset Still’s disease in connective tissue diseases , 2020, Clinical Rheumatology.

[4]  E. Feist,et al.  Mechanisms, biomarkers and targets for adult-onset Still’s disease , 2018, Nature Reviews Rheumatology.

[5]  Y. Shoenfeld,et al.  A comprehensive review on adult onset Still's disease. , 2018, Journal of autoimmunity.

[6]  B. Fautrel,et al.  Complications of adult-onset Still’s disease and their management , 2018, Expert review of clinical immunology.

[7]  G. Schett,et al.  The value of 18F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study , 2017, Annals of the rheumatic diseases.

[8]  Hongcheng Shi,et al.  Imaging characteristics of adult onset Still's disease demonstrated with 18F-FDG PET/CT. , 2017, Molecular medicine reports.

[9]  A. Aouba,et al.  Giant-cell arteritis: concordance study between aortic CT angiography and FDG-PET/CT in detection of large-vessel involvement , 2017, European Journal of Nuclear Medicine and Molecular Imaging.

[10]  K. Kubota,et al.  Clinical Value of FDG-PET/CT for the Evaluation of Rheumatic Diseases: Rheumatoid Arthritis, Polymyalgia Rheumatica, and Relapsing Polychondritis. , 2017, Seminars in nuclear medicine.

[11]  Sally F Barrington,et al.  FDG PET for therapy monitoring in Hodgkin and non-Hodgkin lymphomas , 2017, European Journal of Nuclear Medicine and Molecular Imaging.

[12]  Y. An,et al.  The role of 18 F-fluorodeoxyglucose positron emission tomography in the assessment of disease activity of adult-onset Still ’ s disease , 2017 .

[13]  M. Valenti,et al.  Adult-onset Still’s disease: evaluation of prognostic tools and validation of the systemic score by analysis of 100 cases from three centers , 2016, BMC Medicine.

[14]  C. Broussolle,et al.  [Pathophysiology, subtypes, and treatments of adult-onset Still's disease: An update]. , 2015, La Revue de medecine interne.

[15]  Liqin Xu,et al.  18F-FDG PET/CT in patients with adult-onset Still’s disease , 2015, Clinical Rheumatology.

[16]  F. Martinon,et al.  Pathogenesis of adult-onset Still’s disease: new insights from the juvenile counterpart , 2014, Immunologic Research.

[17]  T. Henry,et al.  Treatment of adult-onset Still’s disease: a review , 2014, Therapeutics and clinical risk management.

[18]  I. Durieu,et al.  Myocarditis in Adult-Onset Still Disease , 2014, Medicine.

[19]  S. Hess,et al.  18F-FDG-PET/CT in fever of unknown origin: clinical value , 2014, Nuclear medicine communications.

[20]  T. Kano,et al.  Clinical value of 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography in patients with adult-onset Still's disease: A seven-case series and review of the literature , 2014, Modern rheumatology.

[21]  D. Maucort-Boulch,et al.  Adult-Onset Still Disease , 2014, Medicine.

[22]  A. Fauchais,et al.  [Adult-onset Still's disease as a manifestation of malignancy: report of a patient with melanoma and literature review]. , 2014, La Revue de medecine interne.

[23]  W. Zucchini,et al.  The evolution of adult-onset Still disease: an observational and comparative study in a cohort of 76 Italian patients. , 2011, Seminars in arthritis and rheumatism.

[24]  X. Weng,et al.  Retrospective study of 61 patients with adult-onset Still’s disease admitted with fever of unknown origin in China , 2011, Clinical Rheumatology.

[25]  M. Schiller,et al.  Clinical Manifestations but not Cytokine Profiles Differentiate Adult-onset Still’s Disease and Sepsis , 2010, The Journal of Rheumatology.

[26]  Fengchun Zhang,et al.  Clinical features and prognosis in adult-onset still's disease: a study of 104 cases , 2010, Clinical Rheumatology.

[27]  M. Ffrench,et al.  Reactive Hemophagocytic Syndrome in Adult-Onset Still Disease: Clinical Features and Long-Term Outcome: A Case-Control Study of 8 Patients , 2010, Medicine.

[28]  J. Choe,et al.  Clinical significance of 18F-fluoro-dexoxyglucose positron emission tomography in patients with adult-onset Still’s disease: report of two cases and review of literatures , 2010, Rheumatology International.

[29]  P. Moreau,et al.  Analysis of 18F-FDG PET diffuse bone marrow uptake and splenic uptake in staging of Hodgkin’s lymphoma: a reflection of disease infiltration or just inflammation? , 2009, European Journal of Nuclear Medicine and Molecular Imaging.

[30]  M. Govoni,et al.  Adult-onset Still’s disease , 2009, Rheumatology International.

[31]  R. Cron,et al.  Occult macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis. , 2007, The Journal of rheumatology.

[32]  V. Treyer,et al.  F-18 FDG Whole-Body PET for the Assessment of Disease Activity in Patients With Rheumatoid Arthritis , 2006, Clinical nuclear medicine.

[33]  J. Piette,et al.  Reactive haemophagocytic syndrome in adult-onset Still’s disease: a report of six patients and a review of the literature , 2006, Annals of the rheumatic diseases.

[34]  A. Bakkaloğlu,et al.  A multicenter study of patients with adult-onset Still’s disease compared with systemic juvenile idiopathic arthritis , 2006, Clinical Rheumatology.

[35]  R. Hustinx,et al.  Assessment of disease activity in rheumatoid arthritis with (18)F-FDG PET. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[36]  J. Piette,et al.  Proposal for a New Set of Classification Criteria for Adult-Onset Still Disease , 2002, Medicine.

[37]  J. Piette,et al.  Diagnostic value of ferritin and glycosylated ferritin in adult onset Still's disease. , 2001, The Journal of rheumatology.

[38]  W E Palmer,et al.  Quantification of inflammation in the wrist with gadolinium-enhanced MR imaging and PET with 2-[F-18]-fluoro-2-deoxy-D-glucose. , 1995, Radiology.

[39]  M. Akizuki,et al.  Preliminary criteria for classification of adult Still's disease. , 1992, The Journal of rheumatology.

[40]  J. Esdaile,et al.  Adult Still's Disease: Manifestations, Disease Course, and Outcome in 62 Patients , 1991, Medicine.

[41]  L. van de Putte,et al.  Adult-onset Still's disease; clinical and laboratory features, treatment and progress of 45 cases. , 1986, The Quarterly journal of medicine.