Lilburn David M L, Garthwaite Helen S, Ganeshan Balaji, Win Thida, Screaton Nicholas J, Hoy Luke R, Walls Darren, Endozo Raymond, Shortman Robert I, Fraioli Francesco, Wells Athol U, Denton Christopher P, Groves Ashley M, Porter Joanna C
Institute of Nuclear Medicine, University College London Hospital, London, United Kingdom.
PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
J Nucl Med. 2025 Jul 1;66(7):1135-1141. doi: 10.2967/jnumed.125.269497.
There are few effective prognostic biomarkers in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD). We investigated the potential of [F]FDG PET/CT to predict mortality in this population. In total, 45 patients with SSc-ILD (12 men and 33 women; age, 58.9 ± 9.9 y) were prospectively recruited for [F]FDG PET/CT, forming the largest cohort of this type to our knowledge. All patients underwent clinical assessment, including multidisciplinary team review, high-resolution CT evaluation, and pulmonary function tests. The maximum pulmonary uptake on [F]FDG PET/CT (SUV), minimum pulmonary uptake in unaffected or background lung (SUV), and target-to-background ratio (TBR) (SUV/SUV) were quantified using region-of-interest analysis. Kaplan-Meier analysis identified associations with mortality. Associations between [F]FDG PET/CT measurements, pulmonary function tests, and the established model based on sex, age, and lung physiology (known as ILD-GAP) to predict mortality were performed. Stepwise forward Wald-Cox analysis assessed the independence of significant [F]FDG PET/CT measurements from the ILD-GAP index. Synergies between pulmonary [F]FDG PET/CT measurements and ILD-GAP index for risk stratification in patients with SSc-ILD were investigated. Forty-five patients with SSc-ILD were followed for a mean of 44.8 ± 26.1 mo, with 15 deaths (33%) recorded. The mean ± SD SUV was 3.2 ± 1.1, SUV was 0.5 ± 0.3, and TBR was 6.8 ± 2.6. Increased mortality was associated with high pulmonary SUV ( = 0.027), high SUV ( = 0.002), low TBR ( = 0.016), low forced vital capacity ( = 0.021), low carbon monoxide diffusion coefficient ( = 0.021), low transfer factor ( = 0.012), high ILD-GAP score ( = 0.010), and high ILD-GAP index ( = 0.005). Multivariate Cox regression analysis revealed that pulmonary SUV (hazard ratio, 4.2; 95% CI, 1.3-13.4; = 0.017) and ILD-GAP index (hazard ratio, 3.9; 95% CI, 1.2-12.8; = 0.024) were the only independent predictors of overall survival. Combining [F]FDG uptake with ILD-GAP score data in a modified ILD-GAP index refined the ability to predict mortality ( < 0.002). High-background [F]FDG uptake in normal-appearing lung independently predicts overall survival in SSc-ILD and may stratify patients' risk when combined with ILD-GAP score data in a modified ILD-GAP index. High pulmonary [F]FDG uptake is associated with increased mortality in patients with SSc-ILD.
在系统性硬化症相关间质性肺疾病（SSc-ILD）患者中，有效的预后生物标志物很少。我们研究了[F]FDG PET/CT预测该人群死亡率的潜力。总共前瞻性招募了45例SSc-ILD患者（12名男性和33名女性；年龄58.9±9.9岁）进行[F]FDG PET/CT检查，据我们所知，这形成了此类最大的队列。所有患者均接受了临床评估，包括多学科团队评估、高分辨率CT评估和肺功能测试。使用感兴趣区分析对[F]FDG PET/CT上的最大肺摄取量（SUV）、未受影响或背景肺的最小肺摄取量（SUV）以及靶本比（TBR）（SUV/SUV）进行量化。Kaplan-Meier分析确定了与死亡率的关联。进行了[F]FDG PET/CT测量值、肺功能测试以及基于性别、年龄和肺生理学的既定模型（称为ILD-GAP）之间的关联分析以预测死亡率。逐步向前Wald-Cox分析评估了显著的[F]FDG PET/CT测量值相对于ILD-GAP指数的独立性。研究了肺[F]FDG PET/CT测量值与ILD-GAP指数在SSc-ILD患者风险分层中的协同作用。45例SSc-ILD患者平均随访44.8±26.1个月，记录到15例死亡（33%）。平均±标准差SUV为3.2±1.1，SUV为0.5±0.3，TBR为6.8±2.6。死亡率增加与高肺SUV（=0.027）、高SUV（=0.002）、低TBR（=0.016）、低用力肺活量（=0.021）、低一氧化碳弥散系数（=0.021）、低转运因子（=0.012）、高ILD-GAP评分（=0.010）和高ILD-GAP指数（=0.005）相关。多变量Cox回归分析显示，肺SUV（风险比，4.2；95%可信区间，1.3 - 13.4；=0.017）和ILD-GAP指数（风险比，3.9；95%可信区间，1.2 - 12.8；=0.024）是总生存的唯一独立预测因素。在改良的ILD-GAP指数中结合[F]FDG摄取与ILD-GAP评分数据可提高预测死亡率的能力（<0.002）。正常外观肺组织中高背景[F]FDG摄取可独立预测SSc-ILD患者的总生存，并且在改良的ILD-GAP指数中与ILD-GAP评分数据结合时可对患者风险进行分层。高肺[F]FDG摄取与SSc-ILD患者死亡率增加相关。
