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J Nucl Med. 2007; 48 (Supplement 2):288P
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General Clinical Specialties: Musculoskeletal
Musculoskeletal Posters

FDG-PET in idiopathic retroperitoneal fibrosis

Annibale Versari1, Alessandra Palmisano2, Alessandro Fraternali1, Rocco Cobelli3, Carlo Salvarani4, Carlo Buzio2, Diana Salvo1 and Augusto Vaglio2

1 Nuclear Medicine, S.Maria Nuova Hospital, Reggio Emilia, Italy; 2 Clinical Medicine and Nephrology; 3 Radiology, University of Parma, Parma, Italy; 4 Rheumatology, S.Maria Nuova Hospital, Reggio Emilia, Italy

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Objectives: Idiopathic retroperitoneal fibrosis (IRF) is a rare disease characterised by a fibro-inflammatory mass which surrounds the abdominal aorta and the iliac arteries and often causes obstructive uropathy. 18F-FDG PET can assess the metabolic activity of several inflammatory diseases. We explored the ability of FDG-PET to predict response to therapy and post-treatment relapse in IRF patients (pts). Methods: We studied 24 consecutive IRF pts (m/f:16/8; median age 58 yrs, range 9-82). The treatment was oral prednisone for 1 month and then prednisone+methotrexate or tamoxifen for 8 months. CT or MRI were performed at diagnosis, after 4 months of treatment and at the end of treatment. FDG-PET was performed in all pts before treatment, and in 13/24 pts also after the end of therapy. The treatment-induced reduction in size of IRF, as assessed by CT/MRI, was defined as absent if <10%, mild if 10-50%, and marked if >50%. FDG uptake was graded from 0 to 3+. The pts were compared with 24 controls. Results: At diagnosis, 22 (92%) pts showed a pathologic FGD uptake. As compared to the CT/MRI distribution of IRF, two main FDG uptake patterns were identified: diffuse (13/22 pts, 59%), and focal (9/22 pts, 41%). Of the 13 pts with diffuse pattern, 10 had grade 3+, 2 had 2+ and 1 had 1+ uptake; the reduction in size of IRF was marked in 9/10 (90%) pts with grade 3+ and 1 of 2 pts with grade 2+ and absent in 1 with 3+, 1 with 2+ and 1 with 1+. Of the 9 pts with a focal pattern, 3 had grade 3+, 4 had 2+ and 1 had 1+ uptake. A marked response was observed in only 1/3 pts with grade 3+; 2 mild responses in 2/4 pts with grade 2+; no response in 2/3 patients with grade 3+, 2/4 with grade 2+ and 2/2 with grade 1+. Both pts without pathologic uptake showed no reduction. After the end of treatment, 6/13 pts had a residual pathological uptake whereas 7 had no uptake. Post-treatment relapses were observed in 5/6 pts with a residual uptake, and in only 1/7 pts without. Conclusions: The distribution and intensity of vascular FDG uptake may predict response to treatment in IRF patients; a post-treatment residual uptake heralds disease relapse.





This Article
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Right arrow Email this article to a friend
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Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Versari, A.
Right arrow Articles by Vaglio, A.
PubMed
Right arrow Articles by Versari, A.
Right arrow Articles by Vaglio, A.