Defining the clinical utility of PET or PET-CT in idiopathic inflammatory myopathies: A systematic literature review

Georgia Bentick; Jessica Fairley; Suba Nadesapillai; Ian Wicks; Jessica Day

doi:10.1016/j.semarthrit.2022.152107

Defining the clinical utility of PET or PET-CT in idiopathic inflammatory myopathies: A systematic literature review

Semin Arthritis Rheum. 2022 Dec:57:152107. doi: 10.1016/j.semarthrit.2022.152107. Epub 2022 Oct 18.

Authors

Georgia Bentick¹, Jessica Fairley², Suba Nadesapillai³, Ian Wicks⁴, Jessica Day⁵

Affiliations

¹ The Royal Melbourne Hospital, Rheumatology, Parkville, Australia.
² The Royal Melbourne Hospital, Rheumatology, Parkville, Australia; The University of Melbourne, Parkville, Australia.
³ The Royal Melbourne Hospital, Rheumatology, Parkville, Australia; The Royal Melbourne Hospital, Nuclear Medicine, Parkville, Australia.
⁴ The Royal Melbourne Hospital, Rheumatology, Parkville, Australia; The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Inflammation Division, Parkville, Australia.
⁵ The Royal Melbourne Hospital, Rheumatology, Parkville, Australia; The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Inflammation Division, Parkville, Australia. Electronic address: jessica.day2@mh.org.au.

PMID: 36335683
DOI: 10.1016/j.semarthrit.2022.152107

Abstract

Objectives: Positron emission tomography (PET), often combined with computed tomography (CT), is a well-established tool for diagnosing malignancy and inflammatory disease. The idiopathic inflammatory myopathies (IIM) are chronic, multi-system diseases characterised by skeletal muscle inflammation, the potential for extramuscular manifestations such as interstitial lung disease (ILD) and an increased risk of malignancy. We performed a systematic literature review to evaluate the utility of PET or PET-CT in evaluation of IIM.

Methods: A search of Medline and EMBASE from 1990 to 2022 using keywords related to IIM and PET was performed. English language studies of adults with IIM who had PET or PET-CT were included.

Results: Our search identified 1173 potentially relevant abstracts, 19 of which were included. The majority of studies used [18F] fluorodeoxyglucose (FDG) PET or PET-CT scans, while the remainder used [18F] florbetapir and [¹¹C] Pittsburgh compound B ([¹¹C] PIB). The sensitivity and specificity of 18F-FDG-PET or 18F-FDG-PET-CT for diagnosing malignancy compared with standard detection methods was 66.7-94% and 80-97.8%, respectively. The sensitivity of 18F-FDG PET-CT for ILD was 93-100% when high-resolution CT was used as the reference standard. 18F-PET and 18F-FDG-PET-CT appear to accurately detect muscle inflammation, although correlations with clinical measures of IIM disease activity were variable. [18F] florbetapir PET-CT and [¹¹C] PIB PET were able to differentiate sporadic inclusion body myositis (IBM) from non-IBM IIM.

Conclusion: PET-CT holds promise as a single tool that can simultaneously evaluate multiple aspects of IIM. These include screening for associated malignancy, achieving an early diagnosis of ILD and evaluating muscle inflammation.

Keywords: Inflammatory myopathies; Interstitial lung disease; Malignancy screening; Myositis; PET; PET-CT.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Fluorodeoxyglucose F18
Humans
Inflammation / diagnostic imaging
Myositis* / diagnostic imaging
Positron Emission Tomography Computed Tomography*
Positron-Emission Tomography

Substances

florbetapir
Fluorodeoxyglucose F18