Therapeutic Efficacy and Prediction of 18F-FDG PET/CT-Assisted Botulinum Toxin Therapy in Patients With Idiopathic Cervical Dystonia.

Abstract

PURPOSE:

This study aimed to investigate the therapeutic efficacy of 18F-FDG PET/CT-assisted botulinum toxin (BTX) injection therapy and predictive PET findings in relation to a good response in patients with idiopathic cervical dystonia (ICD).

MATERIALS AND METHODS:

A total of 78 patients was enrolled from November 2007 to July 2018. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) score was determined at baseline and 4 weeks after BTX injection guided by electromyography and PET/CT. The number of hypermetabolic muscles, the highest SUVmax among hypermetabolic muscles, and the total SUVmax of hypermetabolic muscles were evaluated as pretreatment PET parameters. A good response was defined as a reduction rate ≥30% and a point decrease ≥15 of the TWSTRS total score.

RESULTS:

Half of the subjects showed a good response. Good responders had significantly higher baseline TWSTRS scores than poor responders (total score, P < 0.001; severity, P < 0.001; disability, P < 0.001; pain, P = 0.026). Good responders also had significantly higher numbers of hypermetabolic muscles and BTX-injected hypermetabolic muscles (P < 0.001, both). In multivariable analysis, the baseline TWSTRS disability subscale score and the number of BTX-injected hypermetabolic muscles were significant predictors for good response (P = 0.001 and P = 0.028). The aforementioned 3 PET parameters were positively correlated with the baseline TWSTRS scores. In addition, PET/CT well detected dystonic deep cervical muscles.

CONCLUSIONS:

FDG PET/CT-assisted BTX injection therapy showed good therapeutic efficacy in ICD patients. The numbers of hypermetabolic cervical muscles and BTX-injected hypermetabolic muscles may be helpful in predicting a good response.

• Authors: Hye Ryeong Kwon, Hyunjong Lee, Duk Hyun Sung, Joon Young Choi
• Journal: Clinical nuclear medicine (Clin Nucl Med) Vol. 47 Issue 12 Pg. e725-e730 (Dec 01 2022) ISSN: 1536-0229 [Electronic] United States
• PMID: 36342802 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Fluorodeoxyglucose F18
• Botulinum Toxins, Type A

Topics

• Humans
• Torticollis (diagnostic imaging, drug therapy)
• Fluorodeoxyglucose F18
• Botulinum Toxins, Type A (therapeutic use)
• Positron Emission Tomography Computed Tomography
• Positron-Emission Tomography
• Treatment Outcome