PET-CT indications and contributions to diagnosis in the rheumatology clinic: a retrospective analysis

Positron emission tomography-computed tomography (PET-CT) is a valuable imaging modality in both oncology and autoimmune or inflammatory diseases. This study evaluates the indications for PET-CT in rheumatology patients, compares PET-CT findings with other imaging modalities, and assesses its contribution to definitive diagnosis. Methods: Between January 2022 and December 2023, 63 patients (38 women, 25 men) who underwent PET-CT at Erciyes University Rheumatology Clinic were retrospectively analyzed. Clinical, laboratory, and imaging findings—including prior CT, magnetic resonance imaging (MRI), and angiographic evaluations—were reviewed. PET-CT findings were classified based on metabolic uptake patterns indicating malignancy, vasculitis, inflammatory involvement, lymphadenopathy, and IgG4-related diseases. PET-CT results were statistically compared with final diagnoses. Results: The most common indications for PET-CT were suspected vasculitis (42.9%), fever/inflammation of unknown origin (30.2%), and suspected malignancy (27.0%). PET-CT detected inflammation in 65.1% of cases, lymphadenopathy in 52.4%, nodules in 41.3%, malignancy in 31.7%, and vasculitis in 20.6%. Vasculitis findings were significantly higher in patients with pre-existing rheumatic disease (p = 0.012), while malignancy-related findings were more frequent in those without (p = 0.025). Anti-SSA and anti-Scl70 positivity were significantly associated with malignancy (p = 0.003 and p = 0.030, respectively). PET-CT effectively detected malignancy (p < 0.001) but showed limited diagnostic accuracy for vasculitis (47.6%). Conclusion: PET-CT complements conventional imaging in evaluating vasculitis, inflammation, and malignancy in rheumatic diseases. However, it is insufficient for diagnosing vasculitis alone, necessitating a comprehensive clinical and laboratory approach. While PET-CT is highly effective in malignancy detection, autoantibody presence should be carefully considered in suspected cases.