Incidental Findings on PET Scan Common Among Patients With Psoriasis

Psoriasis on the back
Psoriasis on the back.
Incidental findings were defined as uncovering a potentially clinically significant image in an asymptomatic patient.

Approximately 12% of patients with moderate to severe psoriasis who underwent a whole-body fluorodeoxyglucose-positron emission tomography/computed tomography scan had clinically significant imaging findings, according to a study published in the Journal of the American Academy of Dermatology.

Researchers of this secondary, cross-sectional study evaluated the prevalence of previously unidentified significant medical conditions that are identified through body imaging for patients with moderate to severe plaque psoriasis who participated in a clinical trial.

Patients enrolled in 1 of 3 vascular inflammation in psoriasis clinical trials ( Identifiers: NCT01553058, NCT02690701, NCT02187172) completed fluorodeoxyglucose-positron emission tomography/computed tomography scans at baseline, in addition to providing detailed demographics, a comprehensive clinical history profile, a current physical examination, and laboratory blood testing. Incidental findings were defined as uncovering a potentially clinically significant image in an asymptomatic patient, and incidentalomas were defined as clinically significant when the radiologist recommended additional testing or imaging. Relevant outcomes were the prevalence of clinically significant incidentalomas and the rate of malignancy.

Of the 259 patients who completed the baseline scans, 68.34% were men, 77.99% were white, mean body mass index was 31.83 kg/m2, and mean age was 45.31 years old. Clinically significant incidental findings were discovered in 31 (11.97%) patients, and of these, 15 (5.79%) were major incidental findings, 10 (3.86%) were moderate incidental findings, 4 (1.54%) were minor incidental findings, and 2 (0.77%) were uncategorized. Univariate logistic regression indicated that for every 10 years of increased age, the chance of identifying a clinically significant incidentaloma increased by 30%. Incidentalomas were found in the lungs, head and neck, colon, and pelvis. Cancer was confirmed in 6 patients, resulting in a 2.31% prevalence of malignancy.  

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Limitations of this study include these results potentially not being generalizable to international patients with moderate to severe psoriasis and clinical trials including uninsured patients with limited healthcare access.

The researchers concluded that “clinically significant findings on [fluorodeoxyglucose-positron emission tomography/computed tomography] imaging are common in otherwise healthy asymptomatic patients with moderate to severe psoriasis participating in clinical trials.”

Disclosures: The included clinical trials received funding from several pharmaceutical companies and multiple authors report associations with pharmaceutical companies. Please refer to the original reference for a full list of authors’ disclosures.

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Wan MT, Torigian DA, Alavi A., et al. Prevalence of clinically significant incidental findings by whole-body FDG-PET/CT scanning in moderate-to-severe psoriasis patients participating in clinical trials [published online January 14, 2019]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.01.008