TY - JOUR
T1 - Rheumatoid pulmonary nodules
T2 - clinical and imaging features compared with malignancy
AU - Koslow, Matthew
AU - Young, Jason R.
AU - Yi, Eunhee S.
AU - Baqir, Misbah
AU - Decker, Paul A.
AU - Johnson, Geoffrey B.
AU - Ryu, Jay H.
N1 - Publisher Copyright:
© 2018, European Society of Radiology.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Objectives: The objective of this study was to identify clinical and imaging features that distinguish rheumatoid lung nodules from malignancy. Methods: We conducted a retrospective review of 73 rheumatoid patients with histologically-proven rheumatoid and malignant lung nodules encountered at Mayo Clinic, Rochester, MN (2001–2016). Medical records and imaging were reviewed including a retrospective blinded review of CT and PET/CT studies. Results: The study cohort had a mean age of 67 ± 11 years (range 45–86) including 44 (60%) women, 82% with a smoking history, 38% with subcutaneous rheumatoid nodules, and 78% with rheumatoid factor seropositivity. Subjects with rheumatoid lung nodules compared to malignancy were younger (59 ± 12 vs 71 ± 9 years, p < 0.001), more likely to manifest subcutaneous rheumatoid nodules (73% vs 20%, p < 0.001) and rheumatoid factor seropositivity (93% vs 68%, p = 0.034) but a history of smoking was common in both groups (p = 0.36). CT features more commonly associated with rheumatoid lung nodules compared to malignancy included multiplicity, smooth border, cavitation, satellite nodules, pleural contact, and a subpleural rind of soft tissue. Optimal sensitivity (77%) and specificity (92%) (AUC 0.85, CI 0.75–0.94) for rheumatoid lung nodule were obtained with ≥ 3 CT findings (≥ 4 nodules, peripheral location, cavitation, satellite nodules, smooth border, and subpleural rind). Key 18 FDG-PET/CT features included low-level metabolism (SUV max 2.7 ± 2 vs 7.2 ± 4.8, p = 0.007) and lack of 18 F-fluorodeoxyglucose (FDG)-avid draining lymph nodes. Conclusion: Rheumatoid lung nodules have distinct CT and PET/CT features compared to malignancy. Patients with rheumatoid lung nodules are younger and more likely to manifest subcutaneous rheumatoid nodules and seropositivity. Key Points: • Rheumatoid lung nodules have distinct clinical and imaging features compared to lung malignancy. • CT features of rheumatoid lung nodules include multiplicity, cavitation, satellite nodules, smooth border, peripheral location, and subpleural rind. • Key PET/CT features include low-level metabolism and lack of FDG-avid draining lymph nodes.
AB - Objectives: The objective of this study was to identify clinical and imaging features that distinguish rheumatoid lung nodules from malignancy. Methods: We conducted a retrospective review of 73 rheumatoid patients with histologically-proven rheumatoid and malignant lung nodules encountered at Mayo Clinic, Rochester, MN (2001–2016). Medical records and imaging were reviewed including a retrospective blinded review of CT and PET/CT studies. Results: The study cohort had a mean age of 67 ± 11 years (range 45–86) including 44 (60%) women, 82% with a smoking history, 38% with subcutaneous rheumatoid nodules, and 78% with rheumatoid factor seropositivity. Subjects with rheumatoid lung nodules compared to malignancy were younger (59 ± 12 vs 71 ± 9 years, p < 0.001), more likely to manifest subcutaneous rheumatoid nodules (73% vs 20%, p < 0.001) and rheumatoid factor seropositivity (93% vs 68%, p = 0.034) but a history of smoking was common in both groups (p = 0.36). CT features more commonly associated with rheumatoid lung nodules compared to malignancy included multiplicity, smooth border, cavitation, satellite nodules, pleural contact, and a subpleural rind of soft tissue. Optimal sensitivity (77%) and specificity (92%) (AUC 0.85, CI 0.75–0.94) for rheumatoid lung nodule were obtained with ≥ 3 CT findings (≥ 4 nodules, peripheral location, cavitation, satellite nodules, smooth border, and subpleural rind). Key 18 FDG-PET/CT features included low-level metabolism (SUV max 2.7 ± 2 vs 7.2 ± 4.8, p = 0.007) and lack of 18 F-fluorodeoxyglucose (FDG)-avid draining lymph nodes. Conclusion: Rheumatoid lung nodules have distinct CT and PET/CT features compared to malignancy. Patients with rheumatoid lung nodules are younger and more likely to manifest subcutaneous rheumatoid nodules and seropositivity. Key Points: • Rheumatoid lung nodules have distinct clinical and imaging features compared to lung malignancy. • CT features of rheumatoid lung nodules include multiplicity, cavitation, satellite nodules, smooth border, peripheral location, and subpleural rind. • Key PET/CT features include low-level metabolism and lack of FDG-avid draining lymph nodes.
KW - Multidetector computed tomography
KW - Multiple pulmonary nodules
KW - PET-CT scan
KW - Rheumatoid arthritis
KW - Rheumatoid nodule
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U2 - 10.1007/s00330-018-5755-x
DO - 10.1007/s00330-018-5755-x
M3 - Article
C2 - 30288558
AN - SCOPUS:85054535571
SN - 0938-7994
VL - 29
SP - 1684
EP - 1692
JO - European radiology
JF - European radiology
IS - 4
ER -