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18F-FDG PET imaging of rheumatoid knee synovitis correlates with dynamic magnetic resonance and sonographic assessments as well as with the serum level of metalloproteinase-3

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess rheumatoid arthritis (RA) synovitis with positron emission tomography (PET) and 18F-fluorodeoxyglucose (18F-FDG) in comparison with dynamic magnetic resonance imaging (MRI) and ultrasonography (US).

Methods

Sixteen knees in 16 patients with active RA were assessed with PET, MRI and US at baseline and 4 weeks after initiation of anti-TNF-α treatment. All studies were performed within 4 days. Visual and semi-quantitative (standardised uptake value, SUV) analyses of the synovial uptake of FDG were performed. The dynamic enhancement rate and the static enhancement were measured after i.v. gadolinium injection and the synovial thickness was measured in the medial, lateral patellar and suprapatellar recesses by US. Serum levels of C-reactive protein (CRP) and metalloproteinase-3 (MMP-3) were also measured.

Results

PET was positive in 69% of knees while MRI and US were positive in 69% and 75%. Positivity on one imaging technique was strongly associated with positivity on the other two. PET-positive knees exhibited significantly higher SUVs, higher MRI parameters and greater synovial thickness compared with PET-negative knees, whereas serum CRP and MMP-3 levels were not significantly different. SUVs were significantly correlated with all MRI parameters, with synovial thickness and with serum CRP and MMP-3 levels at baseline. Changes in SUVs after 4 weeks were also correlated with changes in MRI parameters and in serum CRP and MMP-3 levels, but not with changes in synovial thickness.

Conclusion

18F-FDG PET is a unique imaging technique for assessing the metabolic activity of synovitis. The PET findings are correlated with MRI and US assessments of the pannus in RA, as well as with the classical serum parameter of inflammation, CRP, and the synovium-derived parameter, serum MMP-3. Further studies are warranted to establish the place of metabolic imaging of synovitis in RA.

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Acknowledgements

We would like to thank E. Mailleux for her expertise in joint assessment and E. Deflandre, C. Lust, C. Hauwaert, M. Hirsh and A.M. Jeugmans for their clinical collaboration.

This work was supported by a grant from the F.I.R.S. (CHU Liège)

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Authors and Affiliations

  1. Division of Nuclear Medicine, Center for Cellular and Molecular Therapy, University Hospital of Liège, Liège, Belgium

    Catherine Beckers, Jacqueline Foidart & Roland Hustinx

  2. Department of Bone and Joint Radiology, University Hospital of Liège, Liège, Belgium

    Xavier Jeukens & Stefaan Marcelis

  3. Department of Rheumatology, University Hospital of Liège, Liège, Belgium

    Clio Ribbens, Béatrice André, Philippe Leclercq, Marie-Joëlle Kaiser & Michel G. Malaise

Authors
  1. Catherine Beckers
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  2. Xavier Jeukens
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  3. Clio Ribbens
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  4. Béatrice André
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  5. Stefaan Marcelis
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  6. Philippe Leclercq
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  7. Marie-Joëlle Kaiser
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  8. Jacqueline Foidart
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  9. Roland Hustinx
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  10. Michel G. Malaise
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Corresponding author

Correspondence to Michel G. Malaise.

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Beckers, C., Jeukens, X., Ribbens, C. et al. 18F-FDG PET imaging of rheumatoid knee synovitis correlates with dynamic magnetic resonance and sonographic assessments as well as with the serum level of metalloproteinase-3. Eur J Nucl Med Mol Imaging 33, 275–280 (2006). https://doi.org/10.1007/s00259-005-1952-3

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  • DOI: https://doi.org/10.1007/s00259-005-1952-3

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