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Evbuomwan O, Van Rensburg BJ, Engelbrecht G, Driver CHS, Labuschagne M, Sempa J, Horn-Lodewyk J. The Biodistribution and Utility of 99mTc-Ethylenedicysteine-Deoxyglucose ( 99mTc-Glucosamine) in the Identification of Active Disease in Patients with Rheumatoid Arthritis-a Single Center Prospective Study. Nucl Med Mol Imaging 2024; 58:52-61. [PMID: 38510821 PMCID: PMC10948692 DOI: 10.1007/s13139-023-00823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 03/22/2024] Open
Abstract
Purpose Our objectives were to investigate the utility of 99mTc-ethylenedicysteine-deoxyglucose (ECDG) in identifying active disease in the joints of patients with rheumatoid arthritis (RA), as well as to evaluate the biodistribution of this radiopharmaceutical. Methods A prospective study was conducted at the Department of Nuclear Medicine of the University of the Free State/Universitas Academic Hospital in Bloemfontein, South Africa. Twenty-two participants from the rheumatology department diagnosed with RA according to the ACR/EULAR classification criteria were enrolled. Participants were injected with 20-25 mCi of 99mTc-ECDG. Flow, blood pool, whole body, delayed static, and SPECT/CT images were acquired. Known sites of disease were qualitatively assessed for intensity of uptake, and disease severity was graded (Grade 0-3). Results Twenty-two participants were studied. The median (interquartile range) age was 59 (49-68) years, and the majority (n = 21; 95.5%) were females. There was abnormal increased uptake of 99mTc-ECDG noted in majority of the sites of known disease, including unknown sites. SPECT/CT imaging localized radiotracer uptake specifically to the synovial space. Similar biodistribution of radiotracer was noted in all patients, irrespective of disease severity or fasting status. Conclusion 99mTc-ECDG can efficiently assess disease activity in the joints of patients with RA. It accumulates in sites of both clinical and subclinical disease and might be a very useful tool for the rheumatologist in the management of patients with RA.
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Affiliation(s)
- Osayande Evbuomwan
- Nuclear Medicine Department, University of The Free State, Universitas Academic Hospital, Lower Ground Floor, Logeman Street, Bloemfontein, 9301 South Africa
| | | | - Gerrit Engelbrecht
- Nuclear Medicine Department, University of The Free State, Universitas Academic Hospital, Lower Ground Floor, Logeman Street, Bloemfontein, 9301 South Africa
| | - Cathryn H. S. Driver
- Department of Radiochemistry, South African Nuclear Energy Corporation, Pretoria, South Africa
| | | | - Joseph Sempa
- University of The Free State, Bloemfontein, South Africa
| | - Je’nine Horn-Lodewyk
- Central University of Technology, Bloemfontein, South Africa
- Te Whatu Ora Health, Wellington, New Zealand
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Lehman VT, Tiegs-Heiden CA, Broski SM. Beyond Anatomy: Fat-Suppressed MR and Molecular Imaging of Spinal Pain Generators. Radiol Clin North Am 2024; 62:247-261. [PMID: 38272618 DOI: 10.1016/j.rcl.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Spine pain is highly prevalent and costly, but evaluation with clinical features and anatomic imaging remain limited. Fat-suppressed MR imaging and molecular imaging (MI) may help identify inflammatory, lesional, and malignant causes. Numerous MI agents are available, each with advantages and disadvantages. Herein, FDG PET, prostate-specific membrane antigen (PSMA), bone radiotracers, and others are highlighted. No specific pain MI agents have been identified, but mechanisms of key agents are shown in video format, and the mechanism of PSMA as a theranostic agent is displayed. A multidisciplinary approach is needed to master this topic.
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Affiliation(s)
- Vance T Lehman
- Department of Radiology, Mayo Clinic, 200 1st Street SouthWest, Rochester, MN 55905, USA.
| | | | - Stephen M Broski
- Department of Radiology, Mayo Clinic, 200 1st Street SouthWest, Rochester, MN 55905, USA
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3
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Singh SB, Bhandari S, Bhandari S, Bhandari S, Singh R, Raynor WY, Hess S, Werner TJ, Alavi A, Revheim ME. Role of PET/CT in diagnosing and monitoring disease activity in rheumatoid arthritis: a review. Ann Nucl Med 2024; 38:165-175. [PMID: 38277115 PMCID: PMC10884090 DOI: 10.1007/s12149-023-01896-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024]
Abstract
Rheumatoid Arthritis (RA) is a systemic inflammatory disorder that commonly presents with polyarthritis but can have multisystemic involvement and complications, leading to increased morbidity and mortality. The diagnosis of RA continues to be challenging due to its varied clinical presentations. In this review article, we aim to determine the potential of PET/CT to assist in the diagnosis of RA and its complications, evaluate the therapeutic response to treatment, and predict RA remission. PET/CT has increasingly been used in the last decade to diagnose, monitor treatment response, predict remissions, and diagnose subclinical complications in RA. PET imaging with [18F]-fluorodeoxyglucose ([18F]-FDG) is the most commonly applied radiotracer in RA, but other tracers are also being studied. PET/CT with [18F]-FDG, [18F]-NaF, and other tracers might lead to early identification of RA and timely evidence-based clinical management, decreasing morbidity and mortality. Although PET/CT has been evolving as a promising tool for evaluating and managing RA, more evidence is required before incorporating PET/CT in the standard clinical management of RA.
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Affiliation(s)
- Shashi B Singh
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Sambhawana Bhandari
- Department of Medicine, Division of Rheumatology, Washington University in St Louis, St Louis, MO, USA
| | | | | | | | - William Y Raynor
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB#404, New Brunswick, NJ, 08901, USA
| | - Soren Hess
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mona-Elisabeth Revheim
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Rikshospitalet, Nydalen, Post Box 4950, 0424, Oslo, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Blindern, Post Box 1078, 0316, Oslo, Norway.
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Chaudhari AJ, Abdelhafez YG, Nardo L, Raychaudhuri SP. EXPLORing Arthritis with Total-body Positron Emission Tomography. Semin Musculoskelet Radiol 2023; 27:632-640. [PMID: 37935209 PMCID: PMC10689025 DOI: 10.1055/s-0043-1775746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Arthritis has significant adverse consequences on musculoskeletal tissues and often other organs of the body. Current methods for clinical evaluation of arthritis are suboptimal, and biomarkers that are objective and measurable indicators for monitoring of arthritis disease activity are in critical demand. Recently, total-body positron emission tomography (PET) has been developed that can collect imaging signals synchronously from the entire body at ultra-low doses and reduced scan times. These scanners have increased signal collection efficiency that overcomes several limitations of standard PET scanners in the evaluation of arthritis, and they may potentially provide biomarkers to assess local and systemic impact of the arthritis disease process. This article reviews current results from using total-body PET in the assessment of common arthritic conditions, and it outlines future opportunities and challenges.
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Affiliation(s)
| | - Yasser G. Abdelhafez
- Department of Radiology, University of California, Davis, Davis, California
- Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Lorenzo Nardo
- Department of Radiology, University of California, Davis, Davis, California
| | - Siba P. Raychaudhuri
- Department of Internal Medicine – Rheumatology, University of California, Davis, Davis, California
- Northern California Veterans Affairs Medical Center, Mather, California
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Evbuomwan O, Engelbrecht G, Driver C, Jansen van Rensburg B, Labuschagne M, Horn-Lodewyk J. The prognostic value of 99m Tc-glucosamine imaging in patients with rheumatoid arthritis: a single center prospective study. Nucl Med Commun 2023; 44:953-958. [PMID: 37578319 DOI: 10.1097/mnm.0000000000001747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Poor prognostic factors in rheumatoid arthritis (RA) are associated with a more severe form of the disease. Nuclear medicine functional imaging has shown remarkable merit at identifying active disease in patients with RA and is increasingly being used in this regard. However, its prognostic value has not been evaluated thoroughly. We aimed to assess the prognostic value of technetium-99m ( 99m Tc-) glucosamine imaging in patients with RA. METHODS Twenty-two participants diagnosed by an experienced rheumatologist with RA were recruited for inclusion in the study. Blood samples were obtained from each participant for baseline C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody titer. On the same day, each participant was injected with 20-25 millicurie (mCi) of 99m Tc-glucosamine. Planar and single-photon emission computed tomography images of known disease sites were acquired up to 2 hours after radiopharmaceutical administration. Affected joints were qualitatively assessed and graded for 99m Tc-glucosamine uptake and compared with blood results. RESULTS All participants affected joints had an increased uptake of the radiopharmaceutical, with 14 (63.6%) having elevated RF and anti-CCP antibody titers. Eight of the 14 patients with increased RF and anti-CCP antibodies had grade 3 uptake of 99m Tc-glucosamine. The remaining 6 had grade 2 uptake. A significant correlation between higher grade uptake and increased levels of RF and anti-CCP antibodies ( P = 0.031) was observed. CONCLUSION We found a strong correlation between high-grade disease on imaging and the presence of RF and anti-CCP antibodies in patients with RA.
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Affiliation(s)
- Osayande Evbuomwan
- Department of Nuclear Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein
| | - Gerrit Engelbrecht
- Department of Nuclear Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein
| | | | - Barend Jansen van Rensburg
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State
| | - Mathys Labuschagne
- Clinical Simulation and Skills Unit, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State
| | - Je'nine Horn-Lodewyk
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology Free State, Bloemfontein, South Africa
- Current affiliation: Hawke's Bay Fallen Soldier Memorial Hospital, Te Whatu Ora Health, Hastings, New Zealand
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Noguchi A, Kurita T, Matsuzawa K. Clinical features of atlantoaxial involvement in patients with rheumatoid arthritis using 18F-fluorodeoxyglucose-positron emission tomography with computed tomography. Clin Rheumatol 2023:10.1007/s10067-023-06586-9. [PMID: 37000282 DOI: 10.1007/s10067-023-06586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION/OBJECTIVES Cervical spine involvement is one of the most serious complications in rheumatoid arthritis (RA). The study aim was to assess the clinical significance of atlantoaxial (AA) joint involvement detected by 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) with computed tomography (CT) in patients with RA. METHOD A prospective cross-sectional study was conducted to evaluate AA joint involvement detected by FDG-PET/CT in consecutive RA patients from December 2017 to February 2022. We investigated the relationship between AA joint involvement and clinical data, including disease activity and patients' cervical symptoms. RESULTS Among 48 patients enrolled, abnormal FDG uptake at AA joint was detected in 13 (27%). Rheumatoid factor titre, initial disease activity score 28-erythrocyte sedimentation rate and total standardized uptake value were significantly higher in the 13 patients than in the others (P = 0.004, P < 0.001 and P = 0.001, respectively). All patients with abnormal FDG uptake at AA joint had some cervical symptoms regardless of cervical spine X-ray abnormalities. Neck pain on movement and at rest were more frequent in the 13 patients than in the others (P = 0.001 and P = 0.004, respectively). The most sensitive symptom associated with AA joint involvement was neck pain on movement (sensitivity, 69%), and the most specific symptom was neck pain at rest (specificity, 100%). CONCLUSIONS AA joint involvement was commonly observed by FDG-PET/CT in patients with active RA, independent of radiographic findings. Specific cervical symptoms can be important surrogate markers for detection of potential AA synovitis associated with active RA. Key Points • AA joint involvement was frequently seen in RA with high disease activity independent of radiographic findings. • Neck pain was a hallmark of AA joint involvement reflecting disease activity, and resting pain was highly specific.
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Affiliation(s)
- Atsushi Noguchi
- Department of Internal Medicine, Japanese Red Cross Kitami Hospital, N6E2, Kitami, Hokkaido, 090-8666, Japan.
| | - Takashi Kurita
- Department of Internal Medicine, Japanese Red Cross Kitami Hospital, N6E2, Kitami, Hokkaido, 090-8666, Japan
- Department of Infectious Diseases, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Katsura Matsuzawa
- Department of Radiology, Japanese Red Cross Kitami Hospital, Kitami, Japan
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Li TY, Lin LF, Pan RY, Cheng SN, Wu YT, Chen LC, Chen YC. 18 F-FDG PET/CT imaging for haemophilic arthropathy compared with clinical, radiological and power Doppler sonographic characteristics of 20 haemophilia patients. Haemophilia 2023; 29:640-647. [PMID: 36580375 DOI: 10.1111/hae.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Repeated joint bleeding in haemophilia patients may lead to haemophilic arthropathy with marked inflammation and synovitis. This study investigated the potential of 18 F-fluorodeoxyglucose positron emission tomography-computed tomography (18 F-FDG PET/CT) as a novel diagnostic method for haemophilic arthropathy. MATERIALS AND METHODS We recruited 20 adult haemophilia patients who reported history of hemarthroses in the shoulder, elbow, hip, knee, or ankle joints. All joints were assessed by power Doppler ultrasonography and radiography, and graded by hyperaemia score and Pettersson score, respectively. Joint pain was evaluated by visual analogue score (VAS). Range of motion (ROM), Haemophilia Joint Health Score (HJHS) and annual joint bleeding rate (AJBR) were recorded. Finally, all participants had whole-body 18 F-FDG PET/CT, and maximum standardized uptake value (SUVmax) of the joints being studied was measured. RESULTS Thirteen patients had severe haemophilia, and seven had moderate haemophilia. The mean age was 36 years. PET SUVmax showed significant correlations with VAS, ROM, Pettersson score, hyperaemia score, HJHS score and AJBR in all large joints except hip. Joints with pain, hyperaemia and radiographic changes were found to have higher SUVmax than those without these features. Using Youden's index, the optimal cut-off value for early radiographical arthropathy was found to be between 1.9 and 2.0. CONCLUSION Our study indicates that 18 F-FDG PET/CT imaging correlated well with various conventional diagnostic techniques. It also demonstrated high sensitivity and specificity for early radiographic arthropathy. 18 F-FDG PET/CT imaging may quantitatively evaluate disease activity of most large joints in a single examination and help detect early haemophilic arthropathy.
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Affiliation(s)
- Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Haemophilia Care and Research Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Li-Fan Lin
- Department of Nuclear Medicine and PET center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ru-Yu Pan
- Haemophilia Care and Research Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Orthopaedics, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shin-Nan Cheng
- Haemophilia Care and Research Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Paediatrics, Tung's Taichung Metrohabor Hospital, Taiwan, ROC
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yeu-Chin Chen
- Haemophilia Care and Research Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Division of Haematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
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8
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Jamar F, van der Laken CJ, Panagiotidis E, Steinz MM, van der Geest KSM, Graham RNJ, Gheysens O. Update on Imaging of Inflammatory Arthritis and Related Disorders. Semin Nucl Med 2023; 53:287-300. [PMID: 36155690 DOI: 10.1053/j.semnuclmed.2022.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/30/2022] [Indexed: 11/11/2022]
Abstract
Arthritis and other rheumatic disorders are very frequent in the general population and responsible for a huge physical and disability burden to affected patients as well as a major cost to the society. Precise evaluation often relies on clinical data only but additional imaging may be required i) for a more objective assessment of the disease status, such as in rheumatoid arthritis (RA) or ankylosing spondyloarthritis (AS), ii) for providing prognostic information and evaluating response to treatment or iii) for establishing diagnosis, in patients with unclear clinical picture, such as polymyalgia rheumatica (PMR) and large-vessel vasculitis (LVV). Besides radiological techniques (x-rays, ultrasound, and MRI), functional and molecular imaging has emerged as a valid tool for this purpose in several disorders. Bone scanning has long been a method of choice but is now more used as a triage tool in patients with unclear complaints, including degenerative disorders (eg osteoarthritis). 18F-FDG-PET/CT (FDG) proved efficient in assessing the extent of the disease and response to treatment in RA and related disorders, and to provide accurate diagnosis in some systemic disorders, including PMR and LVV. Based on glucose metabolism, FDG-PET/CT is able to show increased metabolism in peripheral cells involved in inflammation (eg neutrophils, lymphocytes or monocytes/macrophages) but also in fibroblasts that proliferate in the pannus. The lack of specificity of FDG is a limitation and many alternative tracers were developed at the preclinical stage or applied in the clinics, especially within clinical trials. They include imaging of macrophages using translocator protein (TSPO), folate-receptors or other targets on activated cells. These new tools will undoubtedly become more and more available in the everyday clinical workup of patients with rheumatisms. Finally, it should be kept in mind that a very simple tracer, 18F-fluoride is widely more performant in AS than FDG.
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Affiliation(s)
- François Jamar
- Department of Nuclear Medicine, Cliniques universitaires St-Luc and Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium.
| | - Conny J van der Laken
- Department of Rheumatology, Amsterdam University Medical Center - location VU Medical Center, Amsterdam, The Netherlands
| | | | - Maarten M Steinz
- Department of Rheumatology, Amsterdam University Medical Center - location VU Medical Center, Amsterdam, The Netherlands
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Richard N J Graham
- Radiology Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques universitaires St-Luc and Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
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Harnden K, Di Matteo A, Mankia K. When and how should we use imaging in individuals at risk of rheumatoid arthritis? Front Med (Lausanne) 2022; 9:1058510. [PMID: 36507546 PMCID: PMC9726914 DOI: 10.3389/fmed.2022.1058510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
In recent years rheumatologists have begun to shift focus from early rheumatoid arthritis (RA) to studying individuals at risk of developing the disease. It is now possible to use blood, clinical and imaging biomarkers to identify those at risk of progression before the onset of clinical synovitis. The use of imaging, in particular ultrasound (US) and magnetic resonance imaging (MRI), has become much more widespread in individuals at-risk of RA. Numerous studies have demonstrated that imaging can help us understand RA pathogenesis as well as identifying individuals at high risk of progression. In addition, imaging techniques are becoming more sophisticated with newer imaging modalities such as high-resolution peripheral quantitative computed tomography (HR-pQRCT), nuclear imaging and whole body-MRI (WB-MRI) starting to emerge. Imaging studies in at risk individuals are heterogeneous in nature due to the different at-risk populations, imaging modalities and protocols used. This review will explore the available imaging modalities and the rationale for their use in the main populations at risk of RA.
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Graham RN, Panagiotidis E. [18F]FDG PET/CT in rheumatoid arthritis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:234-244. [PMID: 36066112 DOI: 10.23736/s1824-4785.22.03461-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
[18F]fluorodeoxyglucose (FDG) PET/CT can be used to image the inflammation in rheumatoid arthritis. Specifically, the synovial metabolic activity can be evaluated visually and measured using standard uptake values. Fluorine-18-labeled Sodium fluoride (NaF) PET/CT can be used to determine synovial osteoblastic activity. Response assessment using FDG PET/CT is routine in many cancers and this is now an emerging technique for rheumatoid arthritis. Vasculitis in rheumatoid arthritis (RA) can be also studied with FDG PET/CT and aortic calcification with NaF PET/CT. These techniques could be useful in determining RA disease severity. FDG PET/CT is a useful technique to exclude underlying malignancy when RA does not follow the expected course. A number of novel tracers are being studied with regard to their applicability in rheumatoid arthritis and some of these could even be used in a theranostic manner in the future.
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Affiliation(s)
- Richard N Graham
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK -
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Verweij NJF, de Jongh J, Wee MMT, Zwezerijnen GJC, Yaqub M, Voskuyl AE, Lammertsma AA, van Schaardenburg D, Boers M, Lems WF, van der Laken CJ. Whole-Body Macrophage Positron Emission Tomography Imaging for Disease Activity Assessment in Early Rheumatoid Arthritis. J Rheumatol 2022; 49:871-877. [PMID: 35428723 DOI: 10.3899/jrheum.210928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the potential of whole-body positron emission tomography/computed tomography (PET/CT) with a macrophage tracer to image arthritis in patients with early rheumatoid arthritis (RA). METHODS Thirty-five previously untreated, clinically active patients with early RA underwent whole-body PET/CT scanning with the macrophage tracer (R)-[11C]PK11195 in addition to clinical assessment (Disease Activity Score in 44 joints [DAS44]). Tracer uptake was assessed quantitatively as standardized uptake values (SUVs). In addition, 2 readers blinded to clinical assessment visually scored tracer uptake in joints. Clinical and PET variables were compared using Cohen , linear regression/correlation, and t tests, where appropriate. RESULTS All but 1 patient showed enhanced tracer uptake in at least 1 joint. Twelve percent of all joints (171/1470) were visually positive on the PET scan, most frequently the small joints in feet (40%) and hands (37%), followed by wrists (15%). Correlations of visual scores with clinical findings both at patient and joint levels were absent or weak. In contrast, average SUVs in the hands, feet, and whole body showed significant correlations with DAS44 scores, with the best correlation seen in the feet (R2 = 0.29, P < 0.01). CONCLUSION Clinically active patients with early RA had increased joint uptake of a macrophage PET tracer, especially in the feet. Quantitative, but not visual PET measures of whole body and joint groups, particularly the feet, showed moderate and statistically significant correlations with clinical outcome.
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Affiliation(s)
- Nicki J F Verweij
- N.J.F. Verweij, MD, J. de Jongh, MSc, A.E. Voskuyl, MD, Professor, WF. Lems, MD, Professor, C.J. van der Laken, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit
| | - Jerney de Jongh
- N.J.F. Verweij, MD, J. de Jongh, MSc, A.E. Voskuyl, MD, Professor, WF. Lems, MD, Professor, C.J. van der Laken, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit
| | - Marieke M Ter Wee
- M.M. ter Wee, PhD, M. Boers, MD, Professor, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit
| | - Gerben J C Zwezerijnen
- G.J.C. Zwezerijnen, MD, M. Yaqub, PhD, A.A. Lammertsma, PhD, Professor, Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit
| | - Maqsood Yaqub
- G.J.C. Zwezerijnen, MD, M. Yaqub, PhD, A.A. Lammertsma, PhD, Professor, Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit
| | - Alexandre E Voskuyl
- N.J.F. Verweij, MD, J. de Jongh, MSc, A.E. Voskuyl, MD, Professor, WF. Lems, MD, Professor, C.J. van der Laken, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit
| | - Adriaan A Lammertsma
- G.J.C. Zwezerijnen, MD, M. Yaqub, PhD, A.A. Lammertsma, PhD, Professor, Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit
| | - Dirkjan van Schaardenburg
- D. van Schaardenburg, MD, Professor, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, the Netherlands
| | - Maarten Boers
- M.M. ter Wee, PhD, M. Boers, MD, Professor, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit
| | - Willem F Lems
- N.J.F. Verweij, MD, J. de Jongh, MSc, A.E. Voskuyl, MD, Professor, WF. Lems, MD, Professor, C.J. van der Laken, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit
| | - Conny J van der Laken
- N.J.F. Verweij, MD, J. de Jongh, MSc, A.E. Voskuyl, MD, Professor, WF. Lems, MD, Professor, C.J. van der Laken, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit
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Hamar A, Hascsi Z, Pusztai A, Czókolyová M, Végh E, Pethő Z, Gulyás K, Soós B, Kerekes G, Szekanecz É, Hodosi K, Szántó S, Szűcs G, Seres T, Szekanecz Z, Szamosi S. Prospective, simultaneous assessment of joint and vascular inflammation by PET/CT in tofacitinib-treated patients with rheumatoid arthritis: associations with vascular and bone status. RMD Open 2021; 7:e001804. [PMID: 34740980 PMCID: PMC8573670 DOI: 10.1136/rmdopen-2021-001804] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/27/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Attila Hamar
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | | | - Anita Pusztai
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Monika Czókolyová
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Edit Végh
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Zsófia Pethő
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Katalin Gulyás
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Boglárka Soós
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - György Kerekes
- Intensive Care Unit, Department of Medicine, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Éva Szekanecz
- Department of Oncology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Katalin Hodosi
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Sándor Szántó
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
- Department of Sports Medicine, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Gabriella Szűcs
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Tamás Seres
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Zoltán Szekanecz
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Szilvia Szamosi
- Division of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
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Raynor WY, Borja AJ, Hancin EC, Werner TJ, Alavi A, Revheim ME. Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET. PET Clin 2021; 16:295-311. [PMID: 33589389 DOI: 10.1016/j.cpet.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PET imaging with 18F-sodium fluoride (NaF), combined with computed tomography or magnetic resonance, is a sensitive method of assessing bone turnover. Although NaF-PET is gaining popularity in detecting prostate cancer metastases to bone marrow, osseous changes represent secondary effects of cancer cell growth. PET tracers more appropriate for assessing prostate cancer metastases directly portray malignant activity and include 18F-fluciclovine and prostatic specific membrane antigen ligands. Recent studies investigating NaF-PET suggest utility in the assessment of benign musculoskeletal disorders. Emerging applications in assessing traumatic injuries, joint disease, back pain, orthopedic complications, and metabolic bone disease are discussed.
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Affiliation(s)
- William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Emily C Hancin
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway.
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14
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van der Krogt JMA, van Binsbergen WH, van der Laken CJ, Tas SW. Novel positron emission tomography tracers for imaging of rheumatoid arthritis. Autoimmun Rev 2021; 20:102764. [PMID: 33476822 DOI: 10.1016/j.autrev.2021.102764] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 11/30/2022]
Abstract
Positron emission tomography (PET) is a nuclear imaging modality that relies on visualization of molecular targets in tissues, which is nowadays combined with a structural imaging modality such as computed tomography (CT) or Magnetic Resonance Imaging (MRI) and referred to as hybrid PET imaging. This technique allows to image specific immunological targets in rheumatoid arthritis (RA). Moreover, quantification of the PET signal enables highly sensitive monitoring of therapeutic effects on the molecular target. PET may also aid in stratification of the immuno-phenotype at baseline in order to develop personalized therapy. In this systematic review we will provide an overview of novel PET tracers, investigated in the context of RA, either pre-clinically, or clinically, that specifically visualize immune cells or stromal cells, as well as other factors and processes that contribute to pathology. The potential of these tracers in RA diagnosis, disease monitoring, and prediction of treatment outcome will be discussed. In addition, novel PET tracers established within the field of oncology that may be of use in RA will also be reviewed in order to expand the future opportunities of PET imaging in RA.
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Affiliation(s)
- Jeffrey M A van der Krogt
- Amsterdam UMC, Location AMC, Amsterdam Rheumatology & Immunology Center (ARC), University of Amsterdam, Amsterdam, the Netherlands; Department of Experimental Immunology, Amsterdam UMC/University of Amsterdam, Amsterdam, the Netherlands
| | - Wouter H van Binsbergen
- Amsterdam UMC, Location VUmc, Amsterdam Rheumatology and Immunology Center (ARC), VU University, Amsterdam, the Netherlands
| | - Conny J van der Laken
- Amsterdam UMC, Location VUmc, Amsterdam Rheumatology and Immunology Center (ARC), VU University, Amsterdam, the Netherlands
| | - Sander W Tas
- Amsterdam UMC, Location AMC, Amsterdam Rheumatology & Immunology Center (ARC), University of Amsterdam, Amsterdam, the Netherlands; Department of Experimental Immunology, Amsterdam UMC/University of Amsterdam, Amsterdam, the Netherlands.
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15
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Chaudhari AJ, Raynor WY, Gholamrezanezhad A, Werner TJ, Rajapakse CS, Alavi A. Total-Body PET Imaging of Musculoskeletal Disorders. PET Clin 2021; 16:99-117. [PMID: 33218607 PMCID: PMC7684980 DOI: 10.1016/j.cpet.2020.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Imaging of musculoskeletal disorders, including arthritis, infection, osteoporosis, sarcopenia, and malignancies, is often limited when using conventional modalities such as radiography, computed tomography (CT), and MR imaging. As a result of recent advances in Positron Emission Tomography (PET) instrumentation, total-body PET/CT offers a longer axial field-of-view, higher geometric sensitivity, and higher spatial resolution compared with standard PET systems. This article discusses the potential applications of total-body PET/CT imaging in the assessment of musculoskeletal disorders.
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Affiliation(s)
- Abhijit J Chaudhari
- Department of Radiology, University of California Davis, 4860 Y Street, Sacramento, CA 95825, USA.
| | - William Y Raynor
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Ali Gholamrezanezhad
- Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Los Angeles, CA 90033, USA
| | - Thomas J Werner
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Chamith S Rajapakse
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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16
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Giraudo C, Kainberger F, Boesen M, Trattnig S. Quantitative Imaging in Inflammatory Arthritis: Between Tradition and Innovation. Semin Musculoskelet Radiol 2020; 24:337-354. [PMID: 32992363 DOI: 10.1055/s-0040-1708823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Radiologic imaging is crucial for diagnosing and monitoring rheumatic inflammatory diseases. Particularly the emerging approach of precision medicine has increased the interest in quantitative imaging. Extensive research has shown that ultrasound allows a quantification of direct signs such as bone erosions and synovial thickness. Dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography (CT) contribute to the quantitative assessment of secondary signs such as osteoporosis or lean mass loss. Magnetic resonance imaging (MRI), using different techniques and sequences, permits in-depth evaluations. For instance, the perfusion of the inflamed synovium can be quantified by dynamic contrast-enhanced imaging or diffusion-weighted imaging, and cartilage injury can be assessed by mapping (T1ρ, T2). Furthermore, the increased metabolic activity characterizing the inflammatory response can be reliably assessed by hybrid imaging (positron emission tomography [PET]/CT, PET/MRI). Finally, advances in intelligent systems are pushing forward quantitative imaging. Complex mathematical algorithms of lesions' segmentation and advanced pattern recognition are showing promising results.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine, DIMED, Radiology Institute, University of Padova, Padova, Italy
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-Guided Therapy, High-Field MR Centre, Medical University of Vienna, Vienna, Austria
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17
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Katal S, Gholamrezanezhad A, Nikpanah M, Christensen TQ, Werner TJ, Saboury B, Alavi A, Hess S. Potential Applications of PET/CT/MR Imaging in Inflammatory Diseases: Part I: Musculoskeletal and Gastrointestinal Systems. PET Clin 2020; 15:547-558. [PMID: 32768367 DOI: 10.1016/j.cpet.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
During the past decades, the role of fludeoxyglucose (FDG)-PET and hybrid PET/computed tomography (CT) has been established clinically in the diagnostic workup of a multitude of infectious and inflammatory disorders. In recent years, the fusion of MR imaging to PET has also been increasingly explored, and this may be especially useful in musculoskeletal and gastrointestinal inflammatory diseases due to exceptional soft tissue contrast and reduced radiation dose. This article outlines the current potential for hybrid molecular imaging in the musculoskeletal system and the gastrointestinal tract with special focus on the potential for fused PET/CT/MR imaging.
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Affiliation(s)
- Sanaz Katal
- Department of Nuclear Medicine/PET-CT, Kowsar Hospital, Shiraz, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Health Sciences Campus, 1500 San Pablo Street, Los Angeles, California 90033, USA.
| | - Moozhan Nikpanah
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Thomas Q Christensen
- Department of Clinical Engineering, Region of Southern Denmark, Esbjerg, Denmark 5000
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark 6700
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18
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de Groot M, Patel N, Manavaki R, Janiczek RL, Bergstrom M, Östör A, Gerlag D, Roberts A, Graves MJ, Karkera Y, Fernando D, Mistry P, Walker A, Wisniacki N, Fryer TD, Jimenez-Royo P. Quantifying disease activity in rheumatoid arthritis with the TSPO PET ligand 18F-GE-180 and comparison with 18F-FDG and DCE-MRI. EJNMMI Res 2019; 9:113. [PMID: 31858293 PMCID: PMC6923307 DOI: 10.1186/s13550-019-0576-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/15/2019] [Indexed: 02/14/2023] Open
Abstract
Purpose While the aetiology of rheumatoid arthritis (RA) remains unclear, many of the inflammatory components are well characterised. For diagnosis and therapy evaluation, in vivo insight into these processes would be valuable. Various imaging probes have shown value including dynamic contrast-enhanced (DCE) MRI and PET/CT using 18F-fluorodeoxyglucose (18F-FDG) or tracers targeting the translocator protein (TSPO). To evaluate 18F-GE-180, a novel TSPO PET tracer, for detecting and quantifying disease activity in RA, we compared 18F-GE-180 uptake with that of 18F-FDG and DCE-MRI measures of inflammation. Methods Eight RA patients with moderate-to-high, stable disease activity and active disease in at least one wrist were included in this study (NCT02350426). Participants underwent PET/CT examinations with 18F-GE-180 and 18F-FDG on separate visits, covering the shoulders and from the pelvis to the feet, including hands and wrists. DCE-MRI was performed on one affected hand. Uptake was compared visually between tracers as judged by an experienced radiologist and quantitatively using the maximum standardised uptake value (SUVmax). Uptake for both tracers was correlated with DCE-MRI parameters of inflammation, including the volume transfer coefficient Ktrans using Pearson correlation (r). Results PET/CT imaging with 18F-GE-180 in RA patients showed marked extra-synovial uptake around the affected joints. Overall sensitivity for detecting clinically affected joints was low (14%). 18F-GE-180 uptake did not or only weakly correlate with DCE-MRI parameters in the wrist (r = 0.09–0.31). 18F-FDG showed higher sensitivity for detecting symptomatic joints (34%), as well as strong positive correlation with DCE-MRI parameters (SUVmax vs. Ktrans: r = 0.92 for wrist; r = 0.68 for metacarpophalangeal joints). Conclusions The correlations between DCE-MRI parameters and 18F-FDG uptake support use of this PET tracer for quantification of inflammatory burden in RA. The TSPO tracer 18F-GE-180, however, has shown limited use for the investigation of RA due to its poor sensitivity and ability to quantify disease activity in RA.
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Affiliation(s)
- Marius de Groot
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK.,Department of Radiology, University of Cambridge, Cambridge, UK
| | - Neel Patel
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK
| | - Roido Manavaki
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Robert L Janiczek
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK
| | - Mats Bergstrom
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK
| | - Andrew Östör
- Monash University, Cabrini Medical Centre, Melbourne, Australia
| | | | - Alexandra Roberts
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - Disala Fernando
- Clinical Unit Cambridge (CUC), GlaxoSmithKline R&D, Addenbrooke's Hospital, Cambridge, UK
| | | | - Adam Walker
- Clinical Unit Cambridge (CUC), GlaxoSmithKline R&D, Addenbrooke's Hospital, Cambridge, UK
| | - Nicolas Wisniacki
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK
| | - Tim D Fryer
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Pilar Jimenez-Royo
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK.
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19
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Yolcu YU, Lehman VT, Bhatti AUR, Goyal A, Alvi MA, Bydon M. Use of Hybrid Imaging Techniques in Diagnosis of Facet Joint Arthropathy: A Narrative Review of Three Modalities. World Neurosurg 2019; 134:201-210. [PMID: 31655232 DOI: 10.1016/j.wneu.2019.10.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022]
Abstract
Facet joint osteoarthritis/arthropathy of the spine is a common cause of back and neck pain that frequently overlaps clinically with other diseases of the spine. Because of the possible overlap, it is crucial to have an accurate diagnostic strategy, especially when determining the management approach. Various strategies have been suggested and adopted, with several these still being used in clinics. Over the years, because of the disadvantages of single-modality imaging methods (computed tomography, magnetic resonance imaging, single-photon emission computed tomography), the interest in radiologic examination started to move toward hybrid imaging techniques. Although the data are mixed, many initial studies have shown promise. However, there are relatively few data with comparative medial branch blocks, and further investigation is needed. Given the advantages and disadvantages of these new techniques, the imaging results have to be interpreted within clinical context and with consideration of the current state of knowledge in the decision-making process.
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Affiliation(s)
- Yagiz Ugur Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Vance T Lehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Atiq Ur Rehman Bhatti
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anshit Goyal
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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20
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Lehman VT, Diehn FE, Broski SM, Nathan MA, Kemp BJ, Larson NB, Shelerud RA, Brault JS, Halasy MP, Maus TP. Comparison of [ 18F] FDG-PET/MRI and Clinical Findings for Assessment of Suspected Lumbar Facet Joint Pain: A Prospective Study to Characterize Candidate Nonanatomic Imaging Biomarkers and Potential Impact on Management. AJNR Am J Neuroradiol 2019; 40:1779-1785. [PMID: 31558502 DOI: 10.3174/ajnr.a6224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/06/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prior retrospective studies have suggested that both T2 hyperintensity and gadolinium enhancement on fat-suppressed MR imaging are associated with lumbar facet joint pain, but prospective evaluation of FDG-PET/MR imaging with a standardized protocol and correlation to clinical findings are lacking. The primary aim was to prospectively assess a standardized FDG-PET/MRI protocol in patients with suspected facetogenic low back pain, with determination of the concordance of imaging and clinical findings. MATERIALS AND METHODS Ten patients with clinically suspected facetogenic low back pain were prospectively recruited with a designation of specific facet joints implicated clinically. Subsequently, patients underwent an FDG-PET/MR imaging examination with gadolinium. Each facet joint was graded for perifacet signal change on MR imaging and FDG activity. The frequency and correlation of MR imaging, FDG-PET, and clinical findings were determined. RESULTS FDG activity showed high concordance with high overall MR imaging scores (concordance correlation coefficient = 0.79). There was concordance of the clinical side of pain with the side of high overall MR imaging scores and increased FDG activity on 12/20 (60%) sides. Both a high overall MR imaging score (concordance correlation coefficient = 0.12) and FDG-PET findings positive for increased activity (concordance correlation coefficient = 0.10) had low concordance with the specific clinically implicated facet joints. Increased FDG activity or high MR imaging scores or both were present in only 10/29 (34%) facet joints that had been clinically selected for percutaneous intervention. Eleven (11%) facet joints that had not been selected for treatment demonstrated these imaging findings. CONCLUSIONS There was low concordance of perifacet signal change and FDG activity with clinically implicated facet joints. This could indicate either the potential to change patient management or a lack of biomarker accuracy. Therefore, additional larger randomized studies with the use of comparative medial branch blocks would be useful to further investigate the clinical utility of these findings.
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Affiliation(s)
- V T Lehman
- From the Departments of Radiology (V.T.L., F.E.D., S.M.B., M.A.N., B.J.K., T.P.M.)
| | - F E Diehn
- From the Departments of Radiology (V.T.L., F.E.D., S.M.B., M.A.N., B.J.K., T.P.M.)
| | - S M Broski
- From the Departments of Radiology (V.T.L., F.E.D., S.M.B., M.A.N., B.J.K., T.P.M.)
| | - M A Nathan
- From the Departments of Radiology (V.T.L., F.E.D., S.M.B., M.A.N., B.J.K., T.P.M.)
| | - B J Kemp
- From the Departments of Radiology (V.T.L., F.E.D., S.M.B., M.A.N., B.J.K., T.P.M.)
| | | | - R A Shelerud
- Physical Medicine and Rehabilitation (R.A.S., J.S.B., M.P.H.), Mayo Clinic, Rochester, Minnesota
| | - J S Brault
- Physical Medicine and Rehabilitation (R.A.S., J.S.B., M.P.H.), Mayo Clinic, Rochester, Minnesota
| | - M P Halasy
- Physical Medicine and Rehabilitation (R.A.S., J.S.B., M.P.H.), Mayo Clinic, Rochester, Minnesota
| | - T P Maus
- From the Departments of Radiology (V.T.L., F.E.D., S.M.B., M.A.N., B.J.K., T.P.M.)
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21
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Can Metabolic Pathways Be Therapeutic Targets in Rheumatoid Arthritis? J Clin Med 2019; 8:jcm8050753. [PMID: 31137815 PMCID: PMC6572063 DOI: 10.3390/jcm8050753] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/05/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022] Open
Abstract
The metabolic rewiring of tumor cells and immune cells has been viewed as a promising source of novel drug targets. Many of the molecular pathways implicated in rheumatoid arthritis (RA) directly modify synovium metabolism and transform the resident cells, such as the fibroblast-like synoviocytes (FLS), and the synovial tissue macrophages (STM), toward an overproduction of enzymes, which degrade cartilage and bone, and cytokines, which promote immune cell infiltration. Recent studies have shown metabolic changes in stromal and immune cells from RA patients. Metabolic disruption in the synovium provide the opportunity to use in vivo metabolism-based imaging techniques for patient stratification and to monitor treatment response. In addition, these metabolic changes may be therapeutically targetable. Thus, resetting metabolism of the synovial membrane offers additional opportunities for disease modulation and restoration of homeostasis in RA. In fact, rheumatologists already use the antimetabolite methotrexate, a chemotherapy agent, for the treatment of patients with inflammatory arthritis. Metabolic targets that do not compromise systemic homeostasis or corresponding metabolic functions in normal cells could increase the drug armamentarium in rheumatic diseases for combination therapy independent of systemic immunosuppression. This article summarizes what is known about metabolism in synovial tissue cells and highlights chemotherapies that target metabolism as potential future therapeutic strategies for RA.
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