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Research ArticleClinical Investigation

Total-Body 18F-FDG PET/CT in Autoimmune Inflammatory Arthritis at Ultra-Low Dose: Initial Observations

Yasser Abdelhafez, Siba P. Raychaudhuri, Dario Mazza, Soumajyoti Sarkar, Heather L. Hunt, Kristin McBride, Mike Nguyen, Denise T. Caudle, Benjamin A. Spencer, Negar Omidvari, Heejung Bang, Simon R. Cherry, Lorenzo Nardo, Ramsey D. Badawi and Abhijit J. Chaudhari
Journal of Nuclear Medicine October 2022, 63 (10) 1579-1585; DOI: https://doi.org/10.2967/jnumed.121.263774
Yasser Abdelhafez
1Department of Radiology, University of California Davis, Davis, California;
2Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt;
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Siba P. Raychaudhuri
3Department of Internal Medicine-Rheumatology, University of California Davis, Davis, California;
4Northern California Veterans Affairs Medical Center, Mather, California;
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Dario Mazza
1Department of Radiology, University of California Davis, Davis, California;
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Soumajyoti Sarkar
3Department of Internal Medicine-Rheumatology, University of California Davis, Davis, California;
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Heather L. Hunt
1Department of Radiology, University of California Davis, Davis, California;
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Kristin McBride
1Department of Radiology, University of California Davis, Davis, California;
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Mike Nguyen
1Department of Radiology, University of California Davis, Davis, California;
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Denise T. Caudle
1Department of Radiology, University of California Davis, Davis, California;
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Benjamin A. Spencer
1Department of Radiology, University of California Davis, Davis, California;
5Department of Biomedical Engineering, University of California Davis, Davis, California; and
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Negar Omidvari
1Department of Radiology, University of California Davis, Davis, California;
5Department of Biomedical Engineering, University of California Davis, Davis, California; and
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Heejung Bang
6Department of Public Health Sciences, University of California Davis, Davis, California
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Simon R. Cherry
1Department of Radiology, University of California Davis, Davis, California;
5Department of Biomedical Engineering, University of California Davis, Davis, California; and
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Lorenzo Nardo
1Department of Radiology, University of California Davis, Davis, California;
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Ramsey D. Badawi
1Department of Radiology, University of California Davis, Davis, California;
5Department of Biomedical Engineering, University of California Davis, Davis, California; and
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Abhijit J. Chaudhari
1Department of Radiology, University of California Davis, Davis, California;
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Abstract

Autoimmune inflammatory arthritides (AIA), such as psoriatic arthritis and rheumatoid arthritis, are chronic systemic conditions that affect multiple joints of the body. Recently, total-body (TB) PET/CT scanners exhibiting superior technical characteristics (total-body coverage, geometric sensitivity) that could benefit AIA evaluation, compared with conventional PET/CT systems, have become available. The objectives of this work were to assess the performance of an ultra-low-dose, 18F-FDG TB PET/CT acquisition protocol for evaluating systemic joint involvement in AIA and to report the association of TB PET/CT measures with joint-by-joint rheumatologic examination and standardized rheumatologic outcome measures. Methods: Thirty participants (24 with AIA and 6 with osteoarthritis) were prospectively enrolled in this single-center, observational study. All participants underwent a TB PET/CT scan for 20 min starting at 40 min after intravenous injection of 78.1 ± 4.7 MBq of 18F-FDG. Qualitative and quantitative evaluation of 18F-FDG uptake and joint involvement were performed from the resulting images and compared with the rheumatologic assessments. Results: TB PET/CT enabled the visualization of 18F-FDG uptake at joints of the entire body, including those of the hands and feet, in a single bed position, and in the same phase of radiotracer uptake. A range of pathologies consistent with AIA (and non-AIA in the osteoarthritis group) were visualized, and the feasibility of extracting PET measures from joints examined by rheumatologic assessments was demonstrated. Of 1,997 evaluable joints, there was concordance between TB PET qualitative assessments and joint-by-joint rheumatologic evaluation in the AIA and non-AIA cohorts for 69.9% and 91.1% joints, respectively, and an additional 20.1% and 8.8% joints, respectively, deemed negative on rheumatologic examination showed PET positivity. On the other hand, 10.0% and 0% joints in the AIA and non-AIA cohorts, respectively, were positive on rheumatologic evaluation but negative on TB PET. Quantitative measures from TB PET in the AIA cohort demonstrated a moderate-to-strong correlation (Spearman ρ = 0.53–0.70, P < 0.05) with the rheumatologic outcome measures. Conclusion: Systemic joint evaluation in AIA (and non-AIA) is feasible with a TB PET/CT system and an ultra-low-dose protocol. Our results provide the foundation for future larger studies to evaluate the possible improvements in AIA joint assessment via the TB PET/CT technology.

  • total-body PET/CT
  • autoimmune arthritis
  • rheumatoid arthritis
  • psoriatic arthritis
  • osteoarthritis

Footnotes

  • Published online May. 19, 2022.

  • © 2022 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 63 (10)
Journal of Nuclear Medicine
Vol. 63, Issue 10
October 1, 2022
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Total-Body 18F-FDG PET/CT in Autoimmune Inflammatory Arthritis at Ultra-Low Dose: Initial Observations
Yasser Abdelhafez, Siba P. Raychaudhuri, Dario Mazza, Soumajyoti Sarkar, Heather L. Hunt, Kristin McBride, Mike Nguyen, Denise T. Caudle, Benjamin A. Spencer, Negar Omidvari, Heejung Bang, Simon R. Cherry, Lorenzo Nardo, Ramsey D. Badawi, Abhijit J. Chaudhari
Journal of Nuclear Medicine Oct 2022, 63 (10) 1579-1585; DOI: 10.2967/jnumed.121.263774

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Total-Body 18F-FDG PET/CT in Autoimmune Inflammatory Arthritis at Ultra-Low Dose: Initial Observations
Yasser Abdelhafez, Siba P. Raychaudhuri, Dario Mazza, Soumajyoti Sarkar, Heather L. Hunt, Kristin McBride, Mike Nguyen, Denise T. Caudle, Benjamin A. Spencer, Negar Omidvari, Heejung Bang, Simon R. Cherry, Lorenzo Nardo, Ramsey D. Badawi, Abhijit J. Chaudhari
Journal of Nuclear Medicine Oct 2022, 63 (10) 1579-1585; DOI: 10.2967/jnumed.121.263774
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Keywords

  • total-body PET/CT
  • autoimmune arthritis
  • rheumatoid arthritis
  • psoriatic arthritis
  • osteoarthritis
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