Similarities and differences in fluorodeoxyglucose positron emission tomography/computed tomography findings in spondyloarthropathy, polymyalgia rheumatica and rheumatoid arthritis
Hiroyuki YamashitaKazuo KubotaYuko TakahashiRyogo MinamimotoMiyako MorookaHiroshi KanekoToshikazu KanoAkio Mimori
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Polymyalgia rheumatica
Spondyloarthropathy
Positron Emission Tomography with FDG to Show Thymic CarcinoidAshley M. Groves1, Hosahalli K. Mohan1, Eva A. Wegner2, Sharon F. Hain1, John B. Bingham3 and Susan E. M. Clarke1Audio Available | Share
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A 65-year-old patient with acute lymphoblastic leukemia presented for an 18fluoro-2-deoxy-d-glucose positron emission tomography computed tomography (18FDG PET) after several courses of chemotherapy for metastatic evaluation. Unexpectedly, on 18FDG PET scan, no discernible uptake was observed in the visceral organs, but instead, the skeleton/bone marrow showed homogenously intense metabolic activity. The distribution of 18FDG observed on the scan was remarkably similar to that on the NaF PET scan, indicating a superscan appearance.
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Positron emission computed tomography (PET) is a functional diagnostic imaging modality. Coupled with computed tomography (CT), it has a high accuracy, adding morphological informations. F-18 fluoro-2-deoxy-D-glucose (FDG), an analogue of glucose, is the most commonly used radiotracer. Its uptake reflects glucose metabolism in the cells which is increased several times in malignant tumors. However FDG is not a cancer specific agent and its uptake has been described in a number of non-neoplastic inflammatory lesions. The aim of our paper is to summarize its major indications in the clinical practice.
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F-18 fluoro-2-deoxyglucose (F-18 FDG) positron emission tomography with computed tomography (PET/CT) is increasingly being used in the diagnosis of inflammatory disorders. We present a case of giant cell arteritis and polymyalgia rheumatica in a 64-year-old woman, identified on F-18 FDG PET/CT scanning during workup for an unknown primary tumor. This case highlights the importance of metabolic imaging in the assessment of extent and activity of large vessel vasculitis and related conditions.
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Polymyalgia rheumatica (PMR) and temporal arteritis (TA) have been associated with a seronegative polyarthritis that can mimic rheumatoid arthritis. Sacroiliitis and osteitis pubis are most often encountered in the different types of spondyloarthropathy. However, sacroiliitis and osteitis pubis have rarely been described in patients with polymyalgia rheumatica and temporal arteritis. We present two patients, one with temporal arteritis and the other with polymyalgia rheumatica, who also had many features of a spondyloarthropathy, including sacroiliitis and osteitis pubis. In reviewing the literature, we found 30 other patients with a diagnosis of PMR who also had sacroiliitis and/or osteitis pubis. We propose that the inflammatory arthritis associated with polymyalgia rheumatica and temporal arteritis can involve the axial joints, resembling a spondyloarthropathy. It is important for the clinician to recognize that sacroiliitis and osteitis pubis have been associated with PMR and TA so that their radiographic presence does not dissuade the clinician from making the correct diagnosis.
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Fluorine-18 fluoro deoxyglucose positron emission tomography (F-18 FDG PET) imaging is an exciting modality for the study of pathophysiology. The fusion of computed tomography (CT) anatomic data to metabolic F-18 FDG PET data allows accurate mapping of the metabolic activity of the body. With each patient evaluated with fusion PET/CT imaging, valuable information is obtained regarding anatomic and physiological abnormalities and normal variants. We describe 4 cases in which the unusual distribution of increased FDG metabolism localized to fat, which we propose represents brown adipose tissue. The accurate anatomic localization of this hypermetabolic fat is aided by imaging these patients on a combined PET/CT system.
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