title: Clinical values of FDG PET in polymyositis and dermatomyositis syndromes: imaging of skeletal muscle inflammation.
abstract: OBJECTIVE
  [(18)F] Fluorodeoxyglucose positron emission tomography (FDG PET), a standard tool for evaluating malignancies, can also detect inflammatory lesions. However, its usefulness in evaluating muscle lesions in polymyositis and dermatomyositis syndromes (PM/DM) has not been established.
  
  
  METHODS
  33 patients with PM/DM who had undergone FDG PET were retrospectively analysed. FDG uptake was visually evaluated (visually identified FDG uptake, vFDG) in 16 regions of the body using mediastinum blood vessels as a positivity criterion. We also calculated the maximum standardised uptake value (SUVmax) in all four limbs of the patients with PM/DM as well as in 22 patients with amyotrophic lateral sclerosis (ALS) with similar disabilities. In 24 patients with PM/DM, MRI and FDG PET findings were compared.
  
  
  RESULTS
  vFDG was observed in multiple muscle lesions with varying distributions in two-thirds of the patients with PM/DM, with most lesions being symmetrical. The number of vFDG-positive regions strongly correlated with the mean SUVmax in all four limbs (p<0.0001). Histological grades of biopsied muscles correlated with both the mean SUVmax and number of vFDG-positive regions. Serum creatine kinase levels were higher in patients with more than two vFDG-positive regions than in those with two or less regions (p<0.05). While the inflamed muscles showed diffused, patchy or marginal signal abnormalities on MRI, FDG uptake was most prominent inside the muscles. Compared with ALS, the mean SUVmax was significantly higher in the patients with PM/DM (p<0.0001) and showed a striking correlation in the bilateral muscles, reflecting symmetrical muscle involvement in PM/DM.
  
  
  CONCLUSIONS
  The visual assessment of FDG uptake as well as calculation of SUV enabled us to comprehensively evaluate skeletal muscle. This method can improve clinical practices and provide insights into pathomechanisms of PM/DM.
authors.affiliation: Department of Neurology, Tohoku University School of Medicine, Sendai, Japan Department of Neurology, Iwate National Hospital, Iwate, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Tateyama
authors.affiliation: Department of Neurology, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Fujihara
authors.affiliation: Department of Neurology, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Misu
authors.affiliation: Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Arai
authors.affiliation: Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kaneta
authors.affiliation: Department of Neurology, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Aoki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000473:pathology; D003402:Creatine Kinase / Q000097:blood; D003882:Dermatomyositis / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism / Q000473:pathology*; D017285:Polymyositis / Q000175:diagnosis / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000378:metabolism; D012189:Retrospective Studies; D013577:Syndrome; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D003402:Creatine Kinase
keywords: HISTOPATHOLOGY; IMMUNOLOGY