Department of Nuclear Medicine, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
AJR Am J Roentgenol. 2020 Jun;214(6):1352-1358. doi: 10.2214/AJR.19.22352. Epub 2020 Apr 14.
We aimed to evaluate the pharmacokinetics and maximum standardized uptake value (SUV) of F-NaF PET/CT for assessment of disease activity and prediction of response in patients with ankylosing spondylitis (AS). Twenty-seven patients (age, interquartile range, 30.25-49.75 years) with AS who were receiving a tumor necrosis factor-α (TNF-α) blocker were included. All patients underwent dynamic PET of the pelvis followed by whole-body PET/CT. Quantitative analysis of kinetic data of the sacroiliac joints (SIJs) was performed, and the SUV of the SIJs and SUV of the spine were calculated. Clinical indexes related to AS disease activity (serum C-reactive protein level, Bath ankylosing spondylitis disease activity index [ BASDAI], and Bath ankylosing spondylitis functional index) were evaluated. Clinical response was defined as an improvement from the initial BASDAI score of 50% or more (BASDAI 50) within 2 years after baseline F-NaF PET/CT. The BASDAI score at F-NaF PET/CT was significantly different between the responders and nonresponders: F-NaF uptake at the spine was significantly higher in the responders than in the nonresponders. Only SUV of the spine had a significant positive correlation with BASDAI score at PET/CT ( = 0.38, = 0.048). The BASDAI score at PET/CT (odds ratio [OR], 35.32; 95% CI, 2.09-57.84; = 0.014) and SUV of the spine (OR, 14.69; 95% CI, 0.79-27.27; = 0.027) were significantly associated with BASDAI 50 response prediction. The results of our study suggest that the SUV of the spine on whole-body F-NaF PET/CT is a reliable and noninvasive biomarker for predicting therapeutic response to TNF-α blocker and shows better performance for predicting response than quantitative pharmacokinetic parameters. Fluorine-18-labeled NaF PET/CT showed axial bone lesions with bone formation and can be used as a monitoring tool in patients with AS receiving anti-TNF-α drugs. However, these results need to be validated in a larger cohort.
我们旨在评估 F-NaF PET/CT 的药代动力学和最大标准化摄取值（SUV），以评估强直性脊柱炎（AS）患者的疾病活动度并预测其反应。共纳入 27 例接受肿瘤坏死因子-α（TNF-α）阻滞剂治疗的 AS 患者（年龄，四分位间距，30.25-49.75 岁）。所有患者均接受骨盆动态 PET 检查，然后行全身 PET/CT 检查。对骶髂关节（SIJ）的动力学数据进行定量分析，并计算 SIJ 的 SUV 和脊柱的 SUV。评估与 AS 疾病活动度相关的临床指标（血清 C 反应蛋白水平、Bath 强直性脊柱炎疾病活动指数[BASDAI]和 Bath 强直性脊柱炎功能指数）。临床反应定义为基线 F-NaF PET/CT 后 2 年内初始 BASDAI 评分降低 50%或更多（BASDAI50）。F-NaF PET/CT 时 BASDAI 评分在应答者和无应答者之间存在显著差异：应答者脊柱 F-NaF 摄取明显高于无应答者。只有脊柱 SUV 与 PET/CT 时的 BASDAI 评分呈显著正相关（r = 0.38，P = 0.048）。PET/CT 时的 BASDAI 评分（比值比[OR]，35.32；95%置信区间[CI]，2.09-57.84；P = 0.014）和脊柱 SUV（OR，14.69；95%CI，0.79-27.27；P = 0.027）与 BASDAI50 反应预测显著相关。我们的研究结果表明，全身 F-NaF PET/CT 的脊柱 SUV 是预测 TNF-α 阻滞剂治疗反应的可靠、非侵入性生物标志物，其预测反应的性能优于定量药代动力学参数。氟-18 标记的 NaF PET/CT 显示成骨轴骨病变，可作为接受抗 TNF-α 药物治疗的 AS 患者的监测工具。然而，这些结果需要在更大的队列中进行验证。
