Nguyen Brian J, Burt Ashley, Baldassarre Randall L, Smitaman Edward, Morshedi Maud, Kao Steven, Chang Eric Y, Obrzut Sebastian
University of California San Diego School of Medicine, La Jolla.
Department of Radiology, University of California San Diego.
Nucl Med Commun. 2018 Jul;39(7):699-706. doi: 10.1097/MNM.0000000000000858.
The objective of this study was to assess the clinical significance of increased fluorine-18-fluorodeoxyglucose (F-FDG) uptake on PET/CT in joints for evaluation of symptomatic osteoarthritis (OA) and prediction of progression.
In this prospective study, shoulder, hip, and knee joints were imaged in 65 patients undergoing routine F-FDG PET/CT imaging. Patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire to assess joint pain, stiffness, and physical function. Standardized uptake values (SUVs) were measured in hip, knee, acromioclavicular (AC), and glenohumeral (GH) joints. Scout PET/CT images were evaluated for OA using the Kellgren and Lawrence (K/L) system. Patients were followed-up for 5 years to determine the progression of OA on the basis of follow-up imaging or surgical intervention.
SUV of knee (r=0.309, P=0.0003), hip (r=0.260, P=0.0027), AC (r=0.186, P=0.0313), and GH (r=0.191, P=0.0271) joints correlated with WOMAC overall scores. Furthermore, SUV of knee (r=0.410, P<0.0001), hip (r=0.203, P=0.0199), and AC (r=0.364, P<0.0001) joints correlated with K/L scores. The area under the receiver operating characteristic curves for SUV were 0.734 (knee), 0.678 (hip), 0.661 (AC), and 0.544 (GH) for symptomatic OA detection based on WOMAC overall z-score greater or equal to 2. Compared with K/L score [hazard ratio (HR)=0.798, P=0.5324], age (HR=0.992, P=0.8978), and WOMAC overall score (HR=1.089, P=0.1265), only SUV (HR=5.653, P=0.0229) was an independent predictor of OA progression in the knees.
F-FDG PET/CT may be helpful with localization of painful abnormalities in the inflamed regions of the joints, which could potentially be used to direct individualized treatment in moderate and severe OA. Furthermore, SUV measurement on F-FDG PET/CT could serve as an inflammation activity index in the knees that may be predictive of outcomes and progression rate of OA.
本研究旨在评估正电子发射断层显像/计算机断层扫描（PET/CT）中关节处氟-18-氟脱氧葡萄糖（F-FDG）摄取增加对于有症状的骨关节炎（OA）评估及病情进展预测的临床意义。
在这项前瞻性研究中，对65例行常规F-FDG PET/CT显像的患者的肩部、髋部和膝关节进行了成像。患者完成了西安大略和麦克马斯特大学骨关节炎指数（WOMAC）问卷，以评估关节疼痛、僵硬和身体功能。在髋、膝、肩锁（AC）和盂肱（GH）关节测量标准化摄取值（SUV）。使用凯尔格伦和劳伦斯（K/L）系统通过PET/CT定位像评估OA。对患者进行了5年的随访，以根据随访成像或手术干预确定OA的进展情况。
膝关节（r = 0.309，P = 0.0003）、髋关节（r = 0.260，P = 0.0027）、AC关节（r = 0.186，P = 0.0313）和GH关节（r = 0.191，P = 0.0271）的SUV与WOMAC总分相关。此外，膝关节（r = 0.410，P < 0.0001）、髋关节（r = 0.203，P = 0.0199）和AC关节（r = 0.364，P < 0.0001）的SUV与K/L评分相关。基于WOMAC总z评分大于或等于2来检测有症状OA时，SUV的受试者工作特征曲线下面积分别为：膝关节0.734、髋关节0.678、AC关节0.661、GH关节0.544。与K/L评分[风险比（HR）= 0.798，P = 0.5324]、年龄（HR = 0.992，P = 0.8978）和WOMAC总分（HR = 1.089，P = 0.1265）相比，只有SUV（HR = 5.653，P = 0.0229）是膝关节OA进展的独立预测因素。
F-FDG PET/CT可能有助于定位关节炎症区域的疼痛异常，这可能潜在地用于指导中重度OA的个体化治疗。此外，F-FDG PET/CT上的SUV测量可作为膝关节的炎症活动指标，可能预测OA的结局和进展速度。
