¹⁸F-FDG PET-CT for the prediction of mortality in patients with dermatomyositis and without malignant tumors: a pilot study

Background: F-18-fluorodeoxyglucose positron emission tomography-computed tomography ( F-18-FDG PET-CT) is typically used to screen malignancy in patients with dermatomyositis (DM). The aim of this study was to investigate the value of using PET-CT in assessing the prognosis of patients with DM and without malignant tumors. Methods: A total of 62 patients with DM who underwent F-18-FDG PET-CT were enrolled in the retrospective cohort study. Clinical data and laboratory indicators were obtained. The muscle max standardized uptake value (SUVmax), splenic SUVmax, target-to-background ratio (TBR) of the aorta, pulmonary highest value (hv)/SUVmax, epicardial fat volume (EFV), and coronary artery calcium (CAC) were measured using F-18-FDG PET-CT. The follow-up was conducted until March 2021, and the endpoint was death from any cause. Univariable and multivariable Cox regression analyses were used to analyze prognostic factors. The survival curves were produced with the Kaplan-Meier method. Results: The median duration of follow-up was 36 [interquartile range (IQR), 14-53] months. The survival rates were 85.2% and 73.4% for 1 and 5 years, respectively. A total of 13 (21.0%) patients died during a median follow-up of 7 (IQR, 4-15.5) months. Compared with the survival group, the death group had significantly higher levels of C-reactive protein [CRP; median (IQR), 4.2 (3.0, 6.0) vs. 6.30 (3.7, 22.8)], hypertension [7 (14.3%) vs. 6 (46.2%)], interstitial lung disease [ILD; 26 (53.1%) vs. 12 (92.3%)], positive anti-Ro52 antibody [19 (38.8%) vs. 10 (76.9%)], pulmonary FDG uptake [median (IQR), 1.8 (1.5, 2.9) vs. 3.5 (2.0, 5.8)], CAC [1 (2.0%) vs. 4 (30.8%)], and EFV [median (IQR), 74.1 (44.8, 92.1) vs. 106.5 (75.0, 128.5)] (all P values < 0.001). Univariable and multivariable Cox analyses identified high pulmonary FDG uptake [hazard ratio (HR), 7.59; 95% confidence interval (CI), 2.08-27.76; P=0.002] and high EFV (HR, 5.86; 95% CI, 1.77-19.42; P=0.004) as independent risk factors for mortality. The survival rate was significantly lower in patients with the concurrent presence of high pulmonary FDG uptake and high EFV. Conclusions: Pulmonary FDG uptake and EFV detected with PET-CT were independent risk factors for death in patients with DM and without malignant tumors. Patients with the concurrent presence of high pulmonary FDG uptake and high EFV had a worse prognosis compared with patients with 1 or neither of these two risk factors. Early treatment should be applied in patients with concurrent presence of high pulmonary FDG uptake and high EFV to improve the survival rate.