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FRI0485 18f-fluorodeoxyglucose positron emission tomography in elderly patients with an elevated erythrocyte sedimentation rate of unknown origin
  1. K. D. F. Lensen1,
  2. A. E. Voskuyl2,
  3. C. J. van der Laken2,
  4. E. F. I. Comans3,
  5. D. van Schaardenburg4,
  6. A. B. Arntzenius5,
  7. T. Zwijnenburg6,
  8. F. Stam7,
  9. M. Gompelman7,
  10. F. van der Zant8,
  11. A. Q. van Paassen9,
  12. B. Voerman10,
  13. F. Smit11,
  14. S. Anten12,
  15. C. E. Siegert13,
  16. A. Binnerts14,
  17. Y. M. Smulders1
  1. 1Internal Medicine
  2. 2Rheumatology
  3. 3Radiology & Nuclear Medicine, VU University Medical Center
  4. 4Rheumatology, Reade/Jan van Breemen Institute, Amsterdam
  5. 5Internal Medicine
  6. 6Nuclear Medicine, Spaarne hospital hoofddorp, Hoofddorp
  7. 7Internal Medicine
  8. 8Nuclear Medicine, Medical Center Alkmaar, Alkmaar
  9. 9Internal Medicine, Kennemer Gasthuis, Haarlem
  10. 10Internal Medicine, Amstelland ziekenhuis, Amstelveen
  11. 11Nuclear Medicine
  12. 12Internal Medicine, Rijnland Hospital, Leiderdorp
  13. 13Internal Medicine, Sint Lucas Andreas Hospital, Amsterdam
  14. 14Internal Medicine, Zaans Medical Center, Zaandam, Netherlands

Abstract

Background 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.

Objectives 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, in order to detect large vessel vasculitis, among other diseases.

Methods In a combined retrospective (A) and prospective (B) study PET/CT was performed in elderly patients (> 50 years of age) who presented with a significantly elevated ESR (≥ 50 mm/h) and non-specific complaints. In addition, a protocolised work-up (including chest X-ray, abdominal ultrasound and protein electrophoresis) was used in study B. In both studies, the final diagnosis was based on histology, clinical follow-up, response to therapy and/or additional imaging.

Results In study A, 30 patients were included. PET/CT results suggested malignancy (8 patients), inflammatory disease (8 patients, including 5 with large-vessel vasculitis) and infection (3 patients). In 2 patients, non-specific abnormalities were found. Of the 21 patients with abnormal PET/CT results, final diagnoses were in accordance with PET/CT results in 12 patients (including 5 with large-vessel vasculitis). In 9 patients, abnormalities detected by PET/CT did not contribute to the final diagnosis. Two diagnoses (tendinitis and acute myeloid leukaemia) were established in 9 patients with a normal scan.

In study B, 58 patients were included. PET/CT results suggested inflammatory disease (25 patients), particularly large-vessel vasculitis (14 cases), infection (5 patients) and malignancy (3 patients). 7 scans demonstrated non-specific abnormalities. Of the 40 patients with abnormal PET/CT results, final diagnoses were in accordance with PET/CT results in 22 patients (including 14 with large-vessel vasculitis). In 18 patients PET/CT abnormalities did not contribute to a final diagnosis. One final diagnosis (PMR) was established in 20 patients with a normal scan.

Conclusions PET/CT may be of potential value in the diagnostic work-up of patients with non-specific complaints and an elevated ESR. 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.

Disclosure of Interest None Declared

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