Abstracts

RETURN TO ABSTRACT LISTING


E1353. Association of PET-CT Detected Adhesive Capsulitis of the Shoulder in Cancer Patients With Shoulder Pain and Stiffness
Authors
  1. Daichi Hayashi; Stony Brook Medicine, Department of Radiology
  2. Elaine Gould; Stony Brook Medicine, Department of Radiology
  3. Robert Shroyer; Stony Brook Medicine, Department of Radiology
  4. Eric van Staalduinen; Stony Brook Medicine, Department of Radiology
  5. Mingqian Huang; Stony Brook Medicine, Department of Radiology
Objective:
1. Describe frequency of shoulder capsulitis in cancer patients undergoing PET-CT; 2. Determine if there is correlation between cancer type/treatment regimen and frequency of adhesive capsulitis; 3. Evaluate if metabolic activities in the rotator interval (RI) are different between patients with and without symptoms

Materials and Methods:
Our prospective study received Institutional Review Board approval. Written informed consent was obtained from all patients, who answered a questionnaire regarding shoulder pain or stiffness and its duration at the time of PET-CT imaging. Data obtained from March 2015 - April 2019 from 252 cancer patients. Patterns of shoulder capsule FDG uptake were noted. Patients with advanced glenohumeral arthrosis/metabolic disease in shoulder were excluded to avoid confounding. SUVmax and SUVmean values were measured at RI and deltoid muscle in bilateral shoulders. Normalized SUV (SUV of RI/SUV of deltoid muscle) was also calculated. Statistical analyses were performed to assess if SUV values are different between patients with and without symptoms in both shoulders. Covariates were age, gender, history of therapy (surgery, chemo, radiation). Wilcoxon rank sum tests were used to compare unadjusted marginal differences for age, SUV measurements between patients with and without shoulder symptoms. Multiple linear regression models were used to examine the relationship between right or left shoulder SUV measurements and symptom status, after adjusting for cancer type, therapy status, gender and age. Statistical significance level was set at p<0.05.

Results:
252 patients were enrolled (143 female, 109 male, mean age 66 years, 67 symptomatic). Of these, 200 patients had PET-CT data. Most common cancer type were lymphoma (n=61), lung (n=54) and breast (n=53). No significant difference was noted between symptomatic and asymptomatic patients in terms of age, gender, proportion of patients who had surgical therapy and radiation therapy. In the right shoulder, higher proportion of asymptomatic patients received chemotherapy compared to symptomatic patients (65% vs 48%, p=0.012). In both shoulders, SUVmax and SUVmean were higher in symptomatic shoulders than asymptomatic shoulders (Left SUVmax 2.0 vs 1.6, SUVmean 1.6 vs 1.3, both p<0.002; Right SUVmax 2.2 vs 1.8, SUVmean 1.8 vs 1.5, both p<0.01). For lung cancer patients, right and left RI SUVmax and SUVmean values were higher in symptomatic shoulders than asymptomatic shoulders. For other cancer patients, symptomatic patients had higher left rotator interval SUVmax/mean than asymptomatic patients after adjustment.

Conclusion:
In symptomatic patients, metabolic activities in RI were higher than asymptomatic patients. Presence of adhesive capsulitis may explain shoulder pain or stiffness in cancer patients, which can be incidentally diagnosed on PET-CT. Demographic characteristics, treatment regimen and cancer type did not appear to be an independent risk factor. Capsulitis should be considered in cancer patients with positive FDG uptake in RI, as it may allow for therapy in earlier stages of disease to improve outcomes.