Muscle fluorodeoxyglucose uptake assessed by positron emission tomography-computed tomography as a biomarker of inflammatory myopathies disease activity

Julien Matuszak; Cyrille Blondet; Fabrice Hubelé; Jacques-Eric Gottenberg; Jean Sibilia; Caroline Bund; Bernard Geny; Izzie Jacques Namer; Alain Meyer

doi:10.1093/rheumatology/kez040

Muscle fluorodeoxyglucose uptake assessed by positron emission tomography-computed tomography as a biomarker of inflammatory myopathies disease activity

Rheumatology (Oxford). 2019 Mar 8:kez040. doi: 10.1093/rheumatology/kez040. Online ahead of print.

Authors

Julien Matuszak¹, Cyrille Blondet^{1

2

3}, Fabrice Hubelé^{1

2

3}, Jacques-Eric Gottenberg⁴, Jean Sibilia⁴, Caroline Bund^{1

2

3}, Bernard Geny⁵, Izzie Jacques Namer^{1

2

3}, Alain Meyer^{2

4

5}

Affiliations

¹ Biophysics and Nuclear Medicine Department, University Hospitals of Strasbourg, Strasbourg, France.
² Federation of Translational Medicine of Strasbourg, Strasbourg University, Strasbourg, France.
³ ICube Joint Research Unit 7357, Illkirch-Graffenstaden, France.
⁴ Rheumatology Department, National Center for Rare Systemic Autoimmune Diseases.
⁵ Physiology and Functional Explorations Department, University Hospitals of Strasbourg, Strasbourg, France.

PMID: 30851092
DOI: 10.1093/rheumatology/kez040

Abstract

Objective: To devise a simple PET-CT score for measurement of muscle disease activity in patients with inflammatory myopathies (IMs) and to assess its validity.

Methods: A total of 44 PET-CT examinations in 34 IM patients (performed during cancer screening) and 20 PET-CT examinations in matched controls (investigated for pulmonary nodules with a conclusion of benignity) were analysed. Maximal standardized uptake values (SUVmax) were recorded bilaterally in eight proximal muscles. The muscle SUVmax (mSUVmax) was defined as the average of the 16 muscle SUVmax values, normalized on the liver mean SUV. Reliability, validity and responsiveness were evaluated.

Results: The mSUVmax was increased in IM patients compared with controls. This index allowed the identification of patients with high vs low muscle disease activity using the myositis intention to treat activity index as the gold standard. In patients with subsequent examinations, our method showed good accuracy to detect changes in muscle disease activity [area under the curve 0.96 (95% CI 0.84, 1)]. Responsiveness was strong. Interrater reliability was excellent.

Conclusion: PET-CT, a non-invasive tool useful for cancer screening, is also valuable to measure muscle disease activity and its evolution in IM patients.

Keywords: FDG PET-CT; antisynthetase syndrome; dermatomyositis; inclusion body myositis; inflammatory myopathies; mysoitis, polymyositis; radionuclide imaging; therapeutic assessment.