Does PET CT Matter in Assessing Extent of Disease in Relapsing Polychondritis - a Single Center Pilot Study

Aman Sharma¹, Adarsh MB², Shankar Naidu³, Varun Dhir⁴, Roshan Verma⁵, Rajender Basher⁵, Anish Bhattacharya⁶, Sanjay Jain⁷ and B R Mittal⁶, ¹Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India, ²Internal Medicine, PGIMER, Chandigarh, India, ³PGIMER, cHANDIGARH, India, ⁴Internal Medicine (Rheumatology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India, ⁵PGIMER, Chandigarh, India, ⁶Nuclear Medicine, PGIMER, Chandigarh, India, ⁷PGIMER, CHANDIGARH, India

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Assessment, polychondritis and positron emission tomography (PET)

Session Information

Date: Tuesday, November 7, 2017

Title: Imaging of Rheumatic Diseases Poster II

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Relapsing polychondritis(RP) is a rare rheumatic disease involving cartilaginous and proteoglycan rich structures. Clinical examination and radiological investigations have limitations in assessing the extent of disease. The study was done to evaluate the role of 18F-FDG PET CT in RP.

Methods:

Thirteen patients who underwent PET CT examination for evaluation of the extent of the disease were included. The diagnosis of RP was made according to Damiani and LevineÕs modification of McAdamÕs criteria. PET CT was done at the time of diagnosis in 11 patients and at disease relapse in two. The FDG uptake along with CT findings were recorded. A follow up PET was done in 3 patients.

Results:

The details of findings are given in Table 1. Mean age was 36.8±12.9 yrs with a Male:Female ratio of 6:7. Out of 12 patients with aural pain/tenderness 5 had increased FDG uptake (SUV max 1.2-8.0) and it was bilateral in all. This gap between clinical findings and FDG uptake may be due to initiation of immunosuppressive therapy before the PET CT as necessitated by the clinical presentation. Non FDG avid thickening of ear was noted in one. Eustachian tube was involved in two patients. Of 8 patients with nasal pain/tenderness only 5 had increased uptake. Of the 4 patients with saddle nose deformity, only one had increased PET uptake in nasal cartilage. Increased FDG uptake was noted in tracheal cartilage in 2 and main bronchus in 4(SUV max 1.6-4.8). Out of four patients with increased FDG uptake in bronchi, three were symptomatic with stridor and breathlessness. Three patients had non FDG avid bronchial thickening on CT. One patient had asymptomatic involvement of aorta, superior mesenteric artery and renal arteries. Two patients with scleritis showed increased uptake in three or more sites. All the three patients on follow up PET showed a response to treatment with all showing persistent thickening with no uptake in involved sites.

Conclusion:

FDG PET is useful in assessing disease extent and picking up involvement in areas not accessible to clinical examination like airways and internal blood vessels. It is also useful is assessing treatment response in these patients

Table 1: showing the clinical characteristics, PET CT abnormalities and treatment outcomes in patients with relapsing polychondritis

S no	Age, Sex	Clinical symptoms and examination findings	PET abnormalities (SUV)				CT finding
S no	Age, Sex	Clinical symptoms and examination findings	Ear nose throat	Airway	Other areas		CT finding
1	46,F	Collapsed nasal bridge, ear pain and tenderness, laryngeal tenderness, Stridor	None	Trachea(2.3), both main bronchii (1.6)		None	Wall thickening of bronchii
2	45,M	Ear pain, scleritis, nasal pain, joint pain, ear tenderness, nasal bridge collapse	None	None		None	Normal
3	26,F	Ear and nasal pain, cough, ear tenderness, laryngeal tenderness	Both ear(1.2 and 1.4), nasal(1.8)	None		None	Both ear thickening
4	33,F	Ear pain, joint pain, ear tenderness, nasal pain and tenderness	Nasal(3.5)	None		None	Normal
5	58,M	Ear pain, ear tenderness, nasal pain and tenderness	Both ear(4.4 and 4.4), nasal(4.0)	None		None	Ear thickening
6	21,F	Ear, nasal pain and tenderness, nasal bridge collapse, joint pain, tracheal tenderness, scleritis	Nasal(4.1)	Trachea (3.3), bronchii (4.4)		Aorta, SMA, Renal arteries, celiac trunk at origin	Thickening of nasal , bronchial and tracheal cartilage, bronchial narrowing
7	37,F	Ear and nasal pain, joint pain, ear and laryngeal tenderness, SNHL	Left Eustachian tube(3.8)	Main bronchii (2.7)		Bone marrow	Thickened Eustachian tube
8	32,F	Ear and nasal pain, stridor, cough, ear and laryngeal tenderness, SNHL	Left eustachean tube (5.9)	Right bronchus (4.3)		None	Right bronchus thickened
9	28,M	Ear pain and tenderness	Both ears (1.2 and 1.1)	None		None	Both ear thickened
10	24,M	Ear pain and tenderness	Both ears (1.3, 1.2), cricoid (3.2)	None		None	Both Ear thickened
11	55,F	Stridor on follow up	None	None		None	Trachea, main bronchi thickened
12	52,M	SNHL, vertigo, red ear, splenic infarcts	Nasal(3.5)	None		None	Ears thickened
13	22,M	Ear pain, nasal pain redness, hoarseness of voice, dermatomyositis	Ear(8.0), vocal cord(13.0)	None		None	Normal

M= Male, F= Female, SNHL= Sensorineural hearing loss

Disclosure: A. Sharma, None; A. MB, None; S. Naidu, None; V. Dhir, None; R. Verma, None; R. Basher, None; A. Bhattacharya, None; S. Jain, None; B. R. Mittal, None.

To cite this abstract in AMA style:

Sharma A, MB A, Naidu S, Dhir V, Verma R, Basher R, Bhattacharya A, Jain S, Mittal BR. Does PET CT Matter in Assessing Extent of Disease in Relapsing Polychondritis – a Single Center Pilot Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/does-pet-ct-matter-in-assessing-extent-of-disease-in-relapsing-polychondritis-a-single-center-pilot-study/. Accessed .

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