18F-fluorodeoxyglucose positron emission tomography in elderly patients with an elevated erythrocyte sedimentation rate of unknown origin

• Published in: PloS one 2013-03, Vol.8 (3), p.e58917-e58917
• Main Authors: Lensen, Karel-Jan D F, Voskuyl, Alexandre E, van der Laken, Conny J, Comans, Emile F I, van Schaardenburg, Dirkjan, Arntzenius, Alex B, Zwijnenburg, Ton, Stam, Frank, Gompelman, Michelle, Zant, Friso M V D, van Paassen, Anneke Q A, Voerman, Bert J, Smit, Frits, Anten, Sander, Siegert, Carl E, Binnerts, Arjen, Smulders, Yvo M
• Format: Article
• Language: English
• Subjects: Abnormalities; Aged; Aged, 80 and over; Arthritis; Blood Sedimentation; Brain - metabolism; Brain - pathology; Computed tomography; Diagnosis; Diagnosis, Differential; Diagnostic systems; Drug dosages; Elderly patients; Emission analysis; Emissions; Erythrocyte sedimentation rate; Erythrocytes; Evaluation; Family medical history; Female; Fever; Fluorine isotopes; Fluorodeoxyglucose F18; Geriatrics; Health aspects; Histology; Hospitals; Humans; Infections; Inflammation; Inflammatory diseases; Internal medicine; Lymphoproliferative Disorders - diagnosis; Male; Malignancy; Medical diagnosis; Medical imaging; Medical research; Medicine; Middle Aged; Multimodal Imaging; NMR; Nuclear magnetic resonance; Nuclear medicine; Older people; Patients; Positron emission; Positron emission tomography; Prospective Studies; Retrospective Studies; Rheumatology; Studies; Systematic review; Tomography; Tomography, X-Ray Computed; Ultrasonic imaging; Vasculitis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0058917

Patients with an elevated erythrocyte sedimentation rate (ESR) and non-specific symptoms often pose a diagnostic dilemma. PET/CT visualises infection, inflammation and malignancy, all of which may cause elevated ESR. The objective of this study was to determine the contribution of 18F-fluorodeoxglucose positron emission tomography (PET/CT) in the diagnostic work-up of referred patients with an elevated ESR, in whom initial routine evaluation did not reveal a diagnosis. We conducted a combined retrospective (A) and prospective (B) study in elderly (>50 years) patients with a significantly elevated ESR of ≥ 50 mm/h and non-specific complaints. In study A, 30 patients were included. Malignancy (8 patients), auto-inflammatory disease (8 patients, including 5 with large-vessel vasculitis) and infection (3 patients) were suggested by PET/CT. Two scans showed non-specific abnormalities and 9 scans were normal. Of the 21 abnormal PET/CT results, 12 diagnoses were independently confirmed and two alternative diagnosis were made. Two diagnoses were established in patients with a normal scan. In study B, 58 patients in whom a prior protocolised work-up was non-diagnostic, were included. Of these, 25 PET/CT-scans showed suspected auto-inflammatory disease, particularly large-vessel vasculitis (14 cases). Infection and malignancy was suspected in 5 and 3 cases, respectively. Seven scans demonstrated non-specific abnormalities, 20 were normal. Of the 40 abnormal PET/CT results, 22 diagnoses were confirmed, 3 alternative diagnoses were established. Only one diagnosis was established in the 20 patients with a normal scan. In both studies, the final diagnosis was based on histology, clinical follow-up, response to therapy or additional imaging. In conclusion, PET/CT may be of potential value in the diagnostic work-up of patients with elevated ESR if routine evaluation reveals no diagnosis. In particular, large-vessel vasculitis appears to be a common finding. A normal PET/CT scan in these patients suggests that it is safe to follow a wait-and-see policy.