Korean J Radiol.  2023 Jun;24(6):590-598. 10.3348/kjr.2022.0576.

Pretherapy ¹⁸F-FDG PET/CT in Predicting Disease Relapse in Patients With Immunoglobulin G4-Related Disease: A Prospective Study

• Cheng MF
• Guo YL
• Yen RF
• Wu YW
• Wang HP

• KMID: 2542854
• DOI: http://doi.org/10.3348/kjr.2022.0576

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.

Keyword

¹⁸F-fluorodeoxyglucose; PET/CT; IgG4-RD; Relapse-free survival; Therapy