Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Pretherapy 18F-FDG PET/CT in Predicting Disease Relapse in Patients With Immunoglobulin G4-Related Disease: A Prospective Study

  • Mei-Fang Cheng (Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Yue Leon Guo (Institute of Environmental and Occupational Health Sciences, National Taiwan University) ;
  • Ruoh-Fang Yen (Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Yen-Wen Wu (Department of Nuclear Medicine, Cardiovascular Medical Center, Far Eastern Memorial Hospital) ;
  • Hsiu-Po Wang (Department of Internal Medicine, National Taiwan University College of Medicine and Hospital)
  • Received : 2022.08.09
  • Accepted : 2023.03.27
  • Published : 2023.06.01
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Abstract

Objective: To investigate whether the levels of inflammation detected by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) can predict disease relapse in immunoglobulin G4-related disease (IgG4-RD) patients receiving standard induction steroid therapy. Materials and Methods: This prospective study analyzed pretherapy FDG PET/CT images from 48 patients (mean age, 63 ± 12.9 years; 45 males and 3 females) diagnosed with IgG4-RD between September 2008 and February 2018, who subsequently received standard induction steroid therapy as the first-line treatment. Multivariable Cox proportional hazards models were used to identify the potential prognostic factors associated with relapse-free survival (RFS). Results: The median follow-up time for the entire cohort was 1913 days (interquartile range [IQR], 803-2929 days). Relapse occurred in 81.3% (39/48) patients during the follow-up period. The median time to relapse was 210 days (IQR, 140-308 days) after completion of standardized induction steroid therapy. Among the 17 parameters analyzed, Cox proportional hazard analysis identified whole-body total lesion glycolysis (WTLG) > 600 on FDG-PET as an independent risk factor for disease relapse (median RFS, 175 vs. 308 days; adjusted hazard ratio, 2.196 [95% confidence interval: 1.080-4.374]; P = 0.030). Conclusion: WTLG on pretherapy FDG PET/CT was the only significant factor associated with RFS in IgG-RD patients receiving standard steroid induction therapy.

Keywords

Acknowledgement

We thank the physicians who referred their patients for inclusion in this clinical trial and who reported their followup data. We are grateful to Mr. Yih-Hwen Huang (Master of Science, Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) for his technical support.

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