European Radiology

, Volume 29, Issue 12, pp 6708–6716 | Cite as

Clinical value of a [18F]-FDG PET-CT muscle-to-muscle SUV ratio for the diagnosis of active dermatomyositis

  • Nihal MartisEmail author
  • Philippe Viau
  • Thierry Zenone
  • Fanny Andry
  • Aurélie Grados
  • Mikael Ebbo
  • Emeline Castela
  • Benoit Brihaye
  • Eric Denis
  • Stéphane Liguori
  • Alexandra Audemard
  • Yoland Schoindre
  • Anne-Sophie Morin
  • Benjamin Terrier
  • Laurent Marcq
  • Nicolas Mounier
  • Olivier Lidove
  • Jean-Philippe Chaborel
  • Denis Quinsat
Nuclear Medicine



To study a muscle-to-muscle standardised uptake value (SUV) ratio with FDG-PET/CT (FDG-PET) as a marker for the detection of disease activity in dermatomyositis (DM).


Patients with DM (n = 24) who met the European Neuro-Muscular Centre diagnostic criteria were retrospectively identified over a 3-year period through a national survey. Muscle biopsy was performed in all patients. Maximum SUV was measured in proximal muscles (SUVPROX) that had the highest radiotracer uptake on visual grading as well as in the musculus longissimus thoracis (SUVMLT), whereas mean SUV was measured for the liver (SUVLIV). Muscle-to-liver SUV ratios for either muscle group were compared and a SUVPROX/SUVMLT ratio was calculated. SUVPROX/SUVMLT of DM patients were compared with age- and sex-matched control subjects (n = 24) with melanoma who had received FDG-PET scans.


DM patients presented with proximal and symmetrical muscle uptake. Differences in SUVPROX/SUVLIV and SUVMLT/SUVLIV ratios in DM subjects were significant (p < 0.001). SUVPROX/SUVMLT ratios in DM and their controls also differed significantly (p = 0.0012). The SUVPROX/SUVMLT ratio threshold between DM subjects and controls was 1.73 with a sensitivity of 50% (CI95%, 29.1 to 70.9%) and specificity at 83.3% (CI95%, 62.6 to 95.3%). When amyopathic DM patients were removed from the analysis, specificity was increased to 95% (CI95%, 75.1 to 99.9%) with a likelihood ratio of 10 and an AUC of 83.4% (CI95%, 71.4 to 95.4%).


A muscle-to-muscle SUVPROX/SUVMLT ratio with a cut-off value of 1.73 in FDG-PET imaging might serve as a non-invasive marker to determine disease activity in dermatomyositis.

Key Points

• [18F]-FDG PET-scanner standardised uptake value (SUV) could reflect disease activity in dermatomyositis (DM).

A ratio of SUV in proximal muscles (SUVPROX) to SUV in musculus longissimus thoracis (SUVMLT) could be used to determine active DM.

• Active disease is suspected for SUV PROX /SUV MLT ratios greater than 1.73.


Positron-emission tomography Fluorodeoxyglucose F18 Myositis Dermatomyositis Amyopathic dermatomyositis 





European Neuro-Muscular Centre


Idiopathic inflammatory myositis


Myositis-associated autoantibodies


Myositis-specific autoantibodies


Standardised uptake value


SUV of the liver


Musculus longissimus thoracis SUV


Proximal muscles SUV



We would like to thank all those who supported and collaborated on this work, especially the Amicale des Jeunes Internistes and the Société Nationale Française de Médecine Interne. Our special thanks to Dr. Arsène Mekinian for his precious advice.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Nihal Martis.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Nicolas Mounier) has significant statistical expertise. No complex statistical methods were necessary for this paper.

Ethical approval

In accordance with French regulation, approval of the institutional review board was not required but the data were collected, stored and handled anonymously as it is usually the case in retrospective studies.

Informed consent

For this type of study, formal patient consent was not required for de-identified data according to French Regulation (“recherche de catégorie 3”).


• retrospective

• diagnostic study

• multicentre study

Supplementary material

330_2019_6302_MOESM1_ESM.docx (108 kb)
ESM 1 (DOCX 108 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Nihal Martis
    • 1
    Email author
  • Philippe Viau
    • 2
  • Thierry Zenone
    • 3
  • Fanny Andry
    • 4
  • Aurélie Grados
    • 5
  • Mikael Ebbo
    • 5
  • Emeline Castela
    • 1
  • Benoit Brihaye
    • 6
  • Eric Denis
    • 7
  • Stéphane Liguori
    • 8
  • Alexandra Audemard
    • 9
  • Yoland Schoindre
    • 10
  • Anne-Sophie Morin
    • 11
  • Benjamin Terrier
    • 12
  • Laurent Marcq
    • 7
  • Nicolas Mounier
    • 13
  • Olivier Lidove
    • 14
  • Jean-Philippe Chaborel
    • 15
  • Denis Quinsat
    • 7
  1. 1.Service de Médecine InterneCHU de Nice, Université Côte d’Azur, Faculté de Médecine de NiceNiceFrance
  2. 2.Service de Médecine Nucléaire, CHU de NiceUniversité Côte d’Azur, Faculté de Médecine de NiceNiceFrance
  3. 3.Service de Médecine InterneCH de ValenceValenceFrance
  4. 4.Service de Médecine InterneCHU MichallonGrenobleFrance
  5. 5.Service de Médecine InterneHôpital La Timone, AP-HMMarseilleFrance
  6. 6.Service de Médecine InterneCH Saint-QuentinSaint-QuentinFrance
  7. 7.Service de Médecine InterneCH d’Antibes-Juan-les-PinsAntibesFrance
  8. 8.Service de Biologie MédicaleCH d’Antibes-Juan-les-PinsAntibesFrance
  9. 9.Service de Médecine InterneCHU de CaenCaenFrance
  10. 10.Service de Médecine InterneHôpital de la Pitié Salpêtrière, AP-HPParisFrance
  11. 11.Service de Médecine InterneHôpital Jean Verdier, AP-HPBondyFrance
  12. 12.Service de Médecine InterneHôpital Cochin, AP-HPParisFrance
  13. 13.Service d’Onco-HématologieCHU de Nice, Université Côte d’Azur, Faculté de Médecine de NiceNiceFrance
  14. 14.Service de Médecine InterneCH Croix St-SimonParisFrance
  15. 15.Service de Médecine Nucléaire, Institut Tzanck MouginsMouginsFrance

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