Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Gastroenterology
Published in: BMC Gastroenterology 1/2024

Open Access 01-12-2024 | Autoimmune Pancreatitis | Research

Potential Added Value of 18F-FDG PET Metabolic Parameters in Predicting Disease Relapse in Type 1 Autoimmune Pancreatitis

Authors: Shengxin Chen, Guanyun Wang, Lang Wu, Dexin Chen, Kaixuan Fang, Wenjing Liu, Baixuan Xu, Ya-qi Zhai, Mingyang Li

Published in: BMC Gastroenterology | Issue 1/2024

Login to get access

Abstract

Background

The predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) metabolic parameters for predicting AIP relapse is currently unknown. This study firstly explored the value of 18F-FDG PET/CT parameters as predictors of type 1 AIP relapse.

Methods

This multicenter retrospective cohort study analyzed 51 patients who received 18F-FDG PET/CT prior to treatment and did not receive maintenance therapy after remission. The study collected baseline characteristics and clinical data and conducted qualitative and semi-quantitative analysis of pancreatic lesions and extrapancreatic organs. The study used three thresholds to select the boundaries of pancreatic lesions to evaluate metabolic parameters, including the maximum standard uptake value (SUVmax), mean standard uptake value (SUVmean), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and tumor-to-normal liver standard uptake value ratio (SUVR). Univariate and multivariate analyses were performed to identify independent predictors and build a recurrence prediction model. The model was internally validated using the bootstrap method and a nomogram was created for clinical application.

Results

In the univariable analysis, the relapsed group showed higher levels of SUVmax (6.0 ± 1.6 vs. 5.2 ± 1.1; P = 0.047), SUVR (2.3 [2.0–3.0] vs. 2.0 [1.6–2.4]; P = 0.026), and TLG2.5 (234.5 ± 149.1 vs. 139.6 ± 102.5; P = 0.020) among the 18F-FDG PET metabolic parameters compared to the non-relapsed group. In the multivariable analysis, serum IgG4 (OR, 1.001; 95% CI, 1.000–1.002; P = 0.014) and TLG2.5 (OR, 1.007; 95% CI, 1.002–1.013; P = 0.012) were independent predictors associated with relapse of type 1 AIP. A receiver-operating characteristic curve of the predictive model with these two predictors demonstrated an area under the curve of 0.806.

Conclusion

18F-FDG PET/CT metabolic parameters, particularly TLG2.5, are potential predictors for relapse in patients with type 1 AIP. A multiparameter model that includes IgG4 and TLG2.5 can enhance the ability to predict AIP relapse.
Literature
1.
Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995;40(7):1561–8.CrossRefPubMed
2.
Blaho M, Dite P, Kunovsky L, Kianicka B. Autoimmune pancreatitis - an ongoing challenge. Adv Med Sci. 2020;65(2):403–8.CrossRefPubMed
3.
Hart PA, Kamisawa T, Brugge WR, Chung JB, Culver EL, Czako L, Frulloni L, Go VL, Gress TM, Kim MH, et al. Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. Gut. 2013;62(12):1771–6.CrossRefPubMed
4.
Kubota K, Kamisawa T, Hirano K, Hirooka Y, Uchida K, Ikeura T, Shiomi H, Ohara H, Shimizu K, Arakura N, et al. Clinical course of type 1 autoimmune pancreatitis patients without steroid treatment: a Japanese multicenter study of 97 patients. J Hepatobiliary Pancreat Sci. 2018;25(4):223–30.CrossRefPubMed
5.
Lee HW, Moon SH, Kim MH, Cho DH, Jun JH, Nam K, Song TJ, Park DH, Lee SS, Seo DW, et al. Relapse rate and predictors of relapse in a large single center cohort of type 1 autoimmune pancreatitis: long-term follow-up results after steroid therapy with short-duration maintenance treatment. J Gastroenterol. 2018;53(8):967–77.CrossRefPubMed
6.
Xin L, Meng QQ, Hu LH, Lin H, Pan J, Hao L, Liu PP, Qian W, Wang LW, Li ZS. Prediction and Management for Relapse of type 1 autoimmune pancreatitis after initial steroid treatment: a long-term follow-up from China. Pancreas. 2018;47(9):1110–4.CrossRefPubMed
7.
Suzuki D, Shimizu K, Tokushige K. Relative rise of serum IgG4 levels after steroid therapy for autoimmune pancreatitis predicts the likelihood of relapse. Pancreas. 2018;47(4):412–7.CrossRefPubMed
8.
Kubota K, Kamisawa T, Okazaki K, Kawa S, Hirano K, Hirooka Y, Uchida K, Shiomi H, Ohara H, Shimizu K, et al. Low-dose maintenance steroid treatment could reduce the relapse rate in patients with type 1 autoimmune pancreatitis: a long-term Japanese multicenter analysis of 510 patients. J Gastroenterol. 2017;52(8):955–64.CrossRefPubMed
9.
Nakamura A, Ozawa M, Watanabe T, Ito T, Muraki T, Hamano H, Koinuma M, Kawa S. Predictive factors for autoimmune pancreatitis relapse after 3 years of maintenance therapy. Pancreas. 2018;47(10):1337–43.CrossRefPubMed
10.
Okazaki K, Chari ST, Frulloni L, Lerch MM, Kamisawa T, Kawa S, Kim MH, Levy P, Masamune A, Webster G, et al. International consensus for the treatment of autoimmune pancreatitis. Pancreatology. 2017;17(1):1–6.CrossRefPubMed
11.
Mi L, Zhao Y, Zhao X, Yin F, Yin X, Li N, Shi J, Han X, Duan X, Zhao M, et al. (18)F-Fluorodeoxyglucose positron emission tomography-computed tomography metabolic parameters before and after Neoadjuvant chemotherapy can predict the postoperative prognosis of locally advanced gastric Cancer. Cancer Biother Radiopharm. 2021;36(8):662–71.PubMed
12.
Jo JH, Chung HW, So Y, Yoo YB, Park KS, Nam SE, Lee EJ, Noh WC. FDG PET/CT to predict recurrence of early breast invasive ductal carcinoma. Diagnostics (Basel). 2022;12(3):694.CrossRefPubMedPubMedCentral
13.
Glaudemans AW, de Vries EF, Galli F, Dierckx RA, Slart RH, Signore A. The use of (18)F-FDG-PET/CT for diagnosis and treatment monitoring of inflammatory and infectious diseases. Clin Dev Immunol. 2013;2013:623036.CrossRefPubMedPubMedCentral
14.
Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, Kim MH, Kloppel G, Lerch MM, Lohr M, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. 2011;40(3):352–8.CrossRefPubMed
15.
Masamune A, Nishimori I, Kikuta K, Tsuji I, Mizuno N, Iiyama T, Kanno A, Tachibana Y, Ito T, Kamisawa T, et al. Randomised controlled trial of long-term maintenance corticosteroid therapy in patients with autoimmune pancreatitis. Gut. 2017;66(3):487–94.CrossRefPubMed
16.
Kim HM, Chung MJ, Chung JB. Remission and relapse of autoimmune pancreatitis: focusing on corticosteroid treatment. Pancreas. 2010;39(5):555–60.CrossRefPubMed
17.
Hirano K, Tada M, Isayama H, Sasahira N, Umefune G, Akiyama D, Watanabe T, Saito T, Takagi K, Takahara N, et al. Outcome of long-term maintenance steroid therapy cessation in patients with autoimmune pancreatitis: a prospective study. J Clin Gastroenterol. 2016;50(4):331–7.CrossRefPubMed
18.
Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, Verzijlbergen FJ, Barrington SF, Pike LC, Weber WA, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42(2):328–54.CrossRefPubMed
19.
Ohtani M, Ofuji K, Akazawa Y, Saito Y, Nosaka T, Ozaki Y, Takahashi K, Naito T, Matsuda H, Hiramatsu K, et al. Clinical usefulness of [18F]-Fluoro-2-Deoxy-d-glucose-positron emission tomography/computed tomography for distinguishing between autoimmune pancreatitis and pancreatic Cancer. Pancreas. 2021;50(7):1014–9.CrossRefPubMed
20.
Okazaki K, Kawa S, Kamisawa T, Ikeura T, Itoi T, Ito T, Inui K, Irisawa A, Uchida K, Ohara H, et al. Amendment of the Japanese consensus guidelines for autoimmune pancreatitis, 2020. J Gastroenterol. 2022;57(4):225–45.CrossRefPubMedPubMedCentral
21.
Kubota K, Watanabe S, Uchiyama T, Kato S, Sekino Y, Suzuki K, Mawatari H, Iida H, Endo H, Fujita K, et al. Factors predictive of relapse and spontaneous remission of autoimmune pancreatitis patients treated/not treated with corticosteroids. J Gastroenterol. 2011;46(6):834–42.CrossRefPubMed
22.
Maire F, Le Baleur Y, Rebours V, Vullierme MP, Couvelard A, Voitot H, Sauvanet A, Hentic O, Levy P, Ruszniewski P, et al. Outcome of patients with type 1 or 2 autoimmune pancreatitis. Am J Gastroenterol. 2011;106(1):151–6.CrossRefPubMed
23.
24.
Zhang J, Jia G, Zuo C, Jia N, Wang H. (18)F- FDG PET/CT helps differentiate autoimmune pancreatitis from pancreatic cancer. BMC Cancer. 2017;17(1):695.CrossRefPubMedPubMedCentral
25.
Nakajo M, Jinnouchi S, Fukukura Y, Tanabe H, Tateno R, Nakajo M. The efficacy of whole-body FDG-PET or PET/CT for autoimmune pancreatitis and associated extrapancreatic autoimmune lesions. Eur J Nucl Med Mol Imaging. 2007;34(12):2088–95.CrossRefPubMed
26.
Mitamura K, Arai-Okuda H, Yamamoto Y, Norikane T, Takami Y, Fujimoto K, Wakiya R, Ozaki H, Dobashi H, Nishiyama Y. Disease activity and response to therapy monitored by [(18)F]FDG PET/CT using volume-based indices in IgG4-related disease. EJNMMI Res. 2020;10(1):153.CrossRefPubMedPubMedCentral
27.
Ishii Y, Serikawa M, Sasaki T, Fujimoto Y, Yamaguchi A, Ogawa T, Noma B, Okazaki A, Yukutake M, Ishigaki T, et al. Impact of sclerosing dacryoadenitis/sialadenitis on relapse during steroid therapy in patients with type 1 autoimmune pancreatitis. Scand J Gastroenterol. 2019;54(2):259–64.CrossRefPubMed
28.
Kuruma S, Kamisawa T, Tabata T, Hara S, Fujiwara T, Kuwata G, Egarashira H, Koizumi K, Setoguchi K, Fujiwara J, et al. Clinical characteristics of patients with autoimmune pancreatitis with or without Mikulicz's disease and Mikulicz's disease alone. Gut Liver. 2013;7(1):96–9.CrossRefPubMed
Metadata
Title
Potential Added Value of 18F-FDG PET Metabolic Parameters in Predicting Disease Relapse in Type 1 Autoimmune Pancreatitis
Authors
Shengxin Chen
Guanyun Wang
Lang Wu
Dexin Chen
Kaixuan Fang
Wenjing Liu
Baixuan Xu
Ya-qi Zhai
Mingyang Li
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2024
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-023-03113-7

Other articles of this Issue 1/2024

BMC Gastroenterology 1/2024 Go to the issue

Research

Inside stent placement is suitable for preoperative biliary drainage in patients with perihilar cholangiocarcinoma

Research

Celiac disease symptom profiles and their relationship to gluten-free diet adherence, mental health, and quality of life

Research

Incidental detection of upper gastrointestinal epithelial neoplasia by screening endoscopy prior to endoscopic ultrasonography in patients with pancreaticobiliary disease

Research

Long-term prognosis after endoscopic submucosal dissection for esophageal cancer in older adult patients

Research

Risk factors and management of gastrointestinal bleeding in patients with or without antiplatelet and anticoagulation therapy: a multicenter real-world prospective study

Research

Endoscopic manifestation of intestinal transplant-associated microangiopathy after stem cell transplantation
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits