18F-FDG PET of the hands with a dedicated high-resolution PEM system (arthro-PET): correlation with PET/CT, radiography and clinical parameters

The aim of this study was to prospectively determine the feasibility and compare the novel use of a positron emission mammography (PEM) scanner with standard PET/CT for evaluating hand osteoarthritis (OA) with F-18-FDG. Institutional review board approval and written informed consent were obtained for this HIPAA-compliant prospective study in which 14 adults referred for oncological F-18-FDG PET/CT underwent dedicated hand PET/CT followed by arthro-PET using the PEM device. Hand radiographs were obtained and scored for the presence and severity of OA. Summed qualitative and quantitative joint glycolytic scores for each modality were compared with the findings on plain radiography and clinical features. Eight patients with clinical and/or radiographic evidence of OA comprised the OA group (mean age 73 +/- 7.7 years). Six patients served as the control group (53.7 +/- 9.3 years). Arthro-PET quantitative and qualitative joint glycolytic scores were highly correlated with PET/CT findings in the OA patients (r = 0.86. p = 0.007; r = 0.94, p = 0.001). Qualitative arthro-PET and PET/CT joint scores were significantly higher in the OA patients than in controls (38.7 +/- 6.6 vs. 32.2 +/- 0.4, p = 0.02; 37.5 +/- 5.4 vs. 32.2 +/- 0.4, p = 0.03, respectively). Quantitative arthro-PET and PET/CT maximum SUV-lean joint scores were higher in the OA patients, although they did not reach statistical significance (20.8 +/- 4.2 vs. 18 +/- 1.8, p = 0.13; 22.8 +/- 5.38 vs. 20.1 +/- 1.54, p= 0.21). By definition, OA patients had higher radiographic joint scores than controls (30.9 +/- 31.3 vs. 0, p = 0.03). Hand imaging using a small field of view PEM system (arthro-PET) with FDG is feasible, performing comparably to PET/CT in assessing metabolic joint activity. Arthro-PET and PET/CT showed higher joint FDG uptake in OA. Further exploration of arthro-PET in arthritis management is warranted.