Objective Positron emission tomography-computed tomography (PET-CT) is a valuable imaging modality in both oncology and autoimmune or inflammatory diseases. This study evaluates the indications for PET-CT in rheumatology patients, compares PET-CT findings with other imaging modalities, and assesses its contribution to definitive diagnosis. Methods Between January 2022 and December 2023, 63 patients (38 women, 25 men) who underwent PET-CT at Erciyes University Rheumatology Clinic were retrospectively analyzed. Clinical, laboratory, and imaging findings—including prior CT, magnetic resonance imaging (MRI), and angiographic evaluations—were reviewed. PET-CT findings were classified based on metabolic uptake patterns indicating malignancy, vasculitis, inflammatory involvement, lymphadenopathy, and IgG4-related diseases. PET-CT results were statistically compared with final diagnoses. Results The most common indications for PET-CT were suspected vasculitis (42.9%), fever/inflammation of unknown origin (30.2%), and suspected malignancy (27.0%). PET-CT detected inflammation in 65.1% of cases, lymphadenopathy in 52.4%, nodules in 41.3%, malignancy in 31.7%, and vasculitis in 20.6%. Vasculitis findings were significantly higher in patients with pre-existing rheumatic disease (p = 0.012), while malignancy-related findings were more frequent in those without (p = 0.025). Anti-SSA and anti-Scl70 positivity were significantly associated with malignancy (p = 0.003 and p = 0.030, respectively). PET-CT effectively detected malignancy (p < 0.001) but showed limited diagnostic accuracy for vasculitis (47.6%). Conclusion PET-CT complements conventional imaging in evaluating vasculitis, inflammation, and malignancy in rheumatic diseases. However, it is insufficient for diagnosing vasculitis alone, necessitating a comprehensive clinical and laboratory approach. While PET-CT is highly effective in malignancy detection, autoantibody presence should be carefully considered in suspected cases.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key points </entry> </row> <row> <entry align="left" nameend="c2" namest="c1"> • Positron emission tomography combined with computed tomography is a significant imaging modality in the field of rheumatology, particularly in the assessment of patients with vasculitis, inflammatory diseases, and suspected malignancy. </entry> </row> <row> <entry align="left" nameend="c2" namest="c1"> • While PET-CT has been shown to have a high degree of accuracy in detecting malignancy, its reliability in diagnosing vasculitis is limited, with a reported reliability of only 47.6%. </entry> </row> <row> <entry align="left" nameend="c2" namest="c1"> • In patients in whom PET-CT was ordered with suspicion of malignancy, a significant association has been demonstrated between anti-SSA and anti-Scl70 positivity and malignancy. </entry> </row> </tbody> </tgroup> </Table>

PET-CT indications and contributions to diagnosis in the rheumatology clinic: a retrospective analysis

期刊论文
发表日期：

2025年8月15日

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Tuğba Kahraman Denizhan,
Hüseyin Kaplan,
Melih Kızıltepe,
Emel Oğuz Kökoğlu,
Celil Barlas Cengiz,
Ummuhan Abdulrezzak,
Abdurrahman Soner Şenel

摘要

Objective

Positron emission tomography-computed tomography (PET-CT) is a valuable imaging modality in both oncology and autoimmune or inflammatory diseases. This study evaluates the indications for PET-CT in rheumatology patients, compares PET-CT findings with other imaging modalities, and assesses its contribution to definitive diagnosis.

Methods

Between January 2022 and December 2023, 63 patients (38 women, 25 men) who underwent PET-CT at Erciyes University Rheumatology Clinic were retrospectively analyzed. Clinical, laboratory, and imaging findings—including prior CT, magnetic resonance imaging (MRI), and angiographic evaluations—were reviewed. PET-CT findings were classified based on metabolic uptake patterns indicating malignancy, vasculitis, inflammatory involvement, lymphadenopathy, and IgG4-related diseases. PET-CT results were statistically compared with final diagnoses.

Results

The most common indications for PET-CT were suspected vasculitis (42.9%), fever/inflammation of unknown origin (30.2%), and suspected malignancy (27.0%). PET-CT detected inflammation in 65.1% of cases, lymphadenopathy in 52.4%, nodules in 41.3%, malignancy in 31.7%, and vasculitis in 20.6%. Vasculitis findings were significantly higher in patients with pre-existing rheumatic disease (p = 0.012), while malignancy-related findings were more frequent in those without (p = 0.025). Anti-SSA and anti-Scl70 positivity were significantly associated with malignancy (p = 0.003 and p = 0.030, respectively). PET-CT effectively detected malignancy (p < 0.001) but showed limited diagnostic accuracy for vasculitis (47.6%).

Conclusion

PET-CT complements conventional imaging in evaluating vasculitis, inflammation, and malignancy in rheumatic diseases. However, it is insufficient for diagnosing vasculitis alone, necessitating a comprehensive clinical and laboratory approach. While PET-CT is highly effective in malignancy detection, autoantibody presence should be carefully considered in suspected cases.

Key points

• Positron emission tomography combined with computed tomography is a significant imaging modality in the field of rheumatology, particularly in the assessment of patients with vasculitis, inflammatory diseases, and suspected malignancy.

• While PET-CT has been shown to have a high degree of accuracy in detecting malignancy, its reliability in diagnosing vasculitis is limited, with a reported reliability of only 47.6%.

• In patients in whom PET-CT was ordered with suspicion of malignancy, a significant association has been demonstrated between anti-SSA and anti-Scl70 positivity and malignancy.