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Persistent FDG/PET CT uptake in idiopathic retroperitoneal fibrosis helps identifying patients at a higher risk for relapse

  • Gabriel Morin
    Affiliations
    Département de Médecine Interne, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France
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  • Arthur Mageau
    Affiliations
    Département de Médecine Interne, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France
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  • Khadija Benali
    Affiliations
    Département de Médecine Nucléaire, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France
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  • Remi Bertinchamp
    Affiliations
    Département de Médecine Interne, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France
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  • Eve Piekarski
    Affiliations
    Département de Médecine Nucléaire, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France
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  • Quentin Raimbourg
    Affiliations
    Département de Nephrologie, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France
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  • Jean-Francois Alexandra
    Affiliations
    Département de Médecine Interne, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France
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  • Tiphaine Goulenok
    Affiliations
    Département de Médecine Interne, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France
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  • Damien van Gysel
    Affiliations
    Département d'Information Médicale, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France
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  • Thomas Papo
    Affiliations
    Département de Médecine Interne, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France

    Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France

    INSERM U1149, Paris, France
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  • Karim Sacre
    Correspondence
    Corresponding author at: Department of Internal Medicine, Bichat Hospital, APHP 46 rue Henri Huchard, 75018 Paris, France.
    Affiliations
    Département de Médecine Interne, Hôpital Bichat, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Paris, France

    Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France

    INSERM U1149, Paris, France
    Search for articles by this author
Published:January 31, 2019DOI:https://doi.org/10.1016/j.ejim.2019.01.019

      Highlights

      • The high rate of IRF relapse led to prolonged therapy in most patients
      • Persistent retroperitoneal fibrosis FDG uptake is an independent factor associated with IRF relapse
      • FDG/PET CT may help clinicians to better target therapy in IRF.

      Abstract

      Background

      The aim of this study was to evaluate the prognostic value of persistent retroperitoneal fibrosis FDG uptake using FDG/PET CT in patients with idiopathic retroperitoneal fibrosis (IRF).

      Methods

      In this monocentric retrospective cohort study, all patients admitted for IRF from January 2009 to December 2017 underwent a FDG/PET CT at diagnosis and during follow up. Metabolic activity of IRF was assessed by retroperitoneal fibrosis FDG uptake measured as maximal standardized uptake value (SUVmax). The primary outcome was IRF relapse rate during follow-up.

      Results

      23 consecutive patients (54.7 [36.9–89] years, 73.9% of men) diagnosed with IRF had FDG/PET CT imaging performed at diagnosis, 3.1 [1–8.7] months (i.e 1st evaluation) and 10.4 [4.9–17.5] months (i.e 2nd evaluation) after diagnosis. High FDG retroperitoneal fibrosis uptake was present in all patients at diagnosis (SUVmax 6.5 [3.8–11.9]) and persisted in 16 (69.6%; SUVmax 3.65 [2.1–5.4]) and 12 (52.2%; SUVmax 3.75 [2.7–7.8]) patients, at 1st and 2nd evaluation respectively. All but one patient had received steroids at IRF diagnosis and 21 (91.3%) were in complete remission at both 1st and 2nd evaluation. During a median follow-up period of 38.7 [3–106.9] months, 6 (26.1%) patients suffered IRF relapse that occurred 15.7 [9.2–42.8] months after diagnosis. Multivariate analysis showed that only persistent retroperitoneal fibrosis FDG uptake at 2nd evaluation was associated with IRF relapse (p = .046).

      Conclusions

      In IRF, persistent retroperitoneal fibrosis FDG uptake during follow up is associated with clinical outcome. FDG/PET CT may help to better stratify the risk of relapse and target therapy in IRF.

      Keywords

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