Ann Rehabil Med.  2013 Dec;37(6):777-784. 10.5535/arm.2013.37.6.777.

Threshold of Clinical Severity of Cervical Dystonia for Positive 18F-FDG PET/CT

• Lee HJ
• An YS
• Ahn YW
• Yim SY

• KMID: 2266556
• DOI: http://doi.org/10.5535/arm.2013.37.6.777

Abstract

OBJECTIVE
To examine whether the clinical severity of cervical dystonia (CD) significantly correlates with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) findings as well as to determine the threshold of the clinical severity of CD for positive 18F-FDG PET/CT study findings.
METHODS
Forty-seven subjects with torticollis as one of the symptoms of CD were included. The clinical severity of CD was evaluated with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) at the time of 18F-FDG PET/CT. The correlation between the clinical severity of CD and the highest SUVmax was examined. The threshold of the clinical severity of CD necessary for positive 18F-FDG PET/CT findings was determined using receiver operating characteristics curve analysis.
RESULTS
Thirty-three of the 47 subjects (70.21%) showed positive 18F-FDG PET/CT findings. The ipsilateral splenius capitis/cervicis, oblique capitis inferior, and longus colli/capitis were the rotators most frequently involved. The highest SUVmax of 18F-FDG PET/CT was significant correlated with the TWSTRS. Subjects with a total TWSTRS exceeding 39 showed positive 18F-FDG PET/CT findings, with those having a total TWSTRS < or =22 showing negative 18F-FDG PET/CT results. The cutoff value of the total TWSTRS for positive 18F-FDG PET/CT findings was set at 27.5 with 90.9% sensitivity and 64.3% specificity.
CONCLUSION
A significant correlation was evident between the clinical severity of CD and 18F-FDG PET/CT findings, providing a threshold of the clinical severity of CD for acquisition of positive 18F-FDG PET/CT findings.

Keyword

Cervical dystonia; Fluorodeoxyglucose F18; Positron-emission tomography

MeSH Terms

Electrons
Fluorodeoxyglucose F18*
Paraspinal Muscles
Positron-Emission Tomography
Positron-Emission Tomography and Computed Tomography*
ROC Curve
Sensitivity and Specificity
Torticollis*
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 (A-C) Correlation between TWSTRS and the highest SUVmax of 18F-fluorodeoxyglucose positron emission tomography/computed tomography. The SUVmax showed significant correlation with (A) the total TWSTRS, (B) severity subscale scores, and (C) disability subscale scores of TWSTRS (p<0.001). (D) There was no correlation between the scores of pain subscale and the SUVmax (p=0.582). The highest value among SUVmaxes of 10 rotators in each subject was defined as the highest SUVmax. SUVmax, maximum standardized uptake value; TWSTRS, Toronto Western Spasmodic Torticollis Rating Scale.

• 

  Fig. 2 Optimal cutoff value of TWSTRS for 18F-FDG PET/CT positive finding selected by receiver operating characteristics curve analysis. (A) The cutoff value of total score of TWSTRS was 27.5. The lowest total score of TWSTRS for the positive 18F-FDG PET/CT findings was 23. All subjects with a total TWSTRS of more than 39 showed positive 18F-FDG PET/CT findings. (B) The cutoff value of severity score of TWSTRS was 11.5. (C) The cutoff value of disability score of TWSTRS was 9.5. TWSTRS, Toronto Western Spasmodic Torticollis Rating Scale; 18F-FDG PET/CT, 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

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