title: 18F-fluorodeoxyglucose positron emission tomography in elderly patients with an elevated erythrocyte sedimentation rate of unknown origin.
abstract: 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. The objective of this study was 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. We conducted a combined retrospective (A) and prospective (B) study in elderly (>50 years) patients with a significantly elevated ESR of ≥ 50 mm/h and non-specific complaints. In study A, 30 patients were included. Malignancy (8 patients), auto-inflammatory disease (8 patients, including 5 with large-vessel vasculitis) and infection (3 patients) were suggested by PET/CT. Two scans showed non-specific abnormalities and 9 scans were normal. Of the 21 abnormal PET/CT results, 12 diagnoses were independently confirmed and two alternative diagnosis were made. Two diagnoses were established in patients with a normal scan. In study B, 58 patients in whom a prior protocolised work-up was non-diagnostic, were included. Of these, 25 PET/CT-scans showed suspected auto-inflammatory disease, particularly large-vessel vasculitis (14 cases). Infection and malignancy was suspected in 5 and 3 cases, respectively. Seven scans demonstrated non-specific abnormalities, 20 were normal. Of the 40 abnormal PET/CT results, 22 diagnoses were confirmed, 3 alternative diagnoses were established. Only one diagnosis was established in the 20 patients with a normal scan. In both studies, the final diagnosis was based on histology, clinical follow-up, response to therapy or additional imaging. In conclusion, PET/CT may be of potential value in the diagnostic work-up of patients with elevated ESR if routine evaluation reveals no diagnosis. 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.
authors.affiliation: Department of Internal Medicine and the Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Karel-Jan D F
authors.initials: KJ
authors.lastname: Lensen
authors.forename: Alexandre E
authors.initials: AE
authors.lastname: Voskuyl
authors.forename: Conny J
authors.initials: CJ
authors.lastname: van der Laken
authors.forename: Emile F I
authors.initials: EF
authors.lastname: Comans
authors.forename: Dirkjan
authors.initials: D
authors.lastname: van Schaardenburg
authors.forename: Alex B
authors.initials: AB
authors.lastname: Arntzenius
authors.forename: Ton
authors.initials: T
authors.lastname: Zwijnenburg
authors.forename: Frank
authors.initials: F
authors.lastname: Stam
authors.forename: Michelle
authors.initials: M
authors.lastname: Gompelman
authors.forename: Friso M V D
authors.initials: FM
authors.lastname: Zant
authors.forename: Anneke Q A
authors.initials: AQ
authors.lastname: van Paassen
authors.forename: Bert J
authors.initials: BJ
authors.lastname: Voerman
authors.forename: Frits
authors.initials: F
authors.lastname: Smit
authors.forename: Sander
authors.initials: S
authors.lastname: Anten
authors.forename: Carl E
authors.initials: CE
authors.lastname: Siegert
authors.forename: Arjen
authors.initials: A
authors.lastname: Binnerts
authors.forename: Yvo M
authors.initials: YM
authors.lastname: Smulders
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001799:Blood Sedimentation; D001921:Brain / Q000378:metabolism / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18