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The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

We aimed to assess the impact of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the management of patients with suspected large vessel vasculitis.

Methods

An international expert panel determined diagnoses and clinical management in patients with suspected large vessel vasculitis, with and without the results of 18F-FDG PET, respectively. The accuracy of the clinical diagnosis and the resulting clinical management with and without the 18F-FDG PET results were compared using logistic regression models.

Results

The analysis included 30 patients referred to a tertiary care centre with large vessel vasculitis and 31 controls. 18F-FDG PET had an overall sensitivity of 73.3% [95% confidence interval (CI) 54.1–87.7%], a specificity of 83.9% (95% CI 66.3–94.5%), a positive predictive value of 81.5% (95% CI 61.9–93.7%) and a negative predictive value of 76.5% (95% CI 58.8–89.3%). The diagnostic accuracy of 18F-FDG PET was higher in patients not receiving immunosuppressive drugs (93.3 vs 64.5%, p = 0.006). Taken in context with other available diagnostic modalities, the addition of 18F-FDG PET increased the clinical diagnostic accuracy from 54.1 to 70.5% (p = 0.04). The addition of 18F-FDG PET increased the number of indicated biopsies from 22 of 61 patients (36.1%) to 25 of 61 patients (41.0%) and changed the treatment recommendation in 8 of 30 patients (26.7%) not receiving immunosuppressive medication and in 7 of 31 patients (22.6%) receiving immunosuppressive medication.

Conclusion

18F-FDG PET is a sensitive and specific imaging tool for large vessel vasculitis, especially when performed in patients not receiving immunosuppressive drugs. It increases the overall diagnostic accuracy and has an impact on the clinical management in a significant proportion of patients.

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References

  1. Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet 2008;372:234–45.

    Article  PubMed  Google Scholar 

  2. Basu N, Watts R, Bajema I, Baslund B, Bley T, Boers M, et al. EULAR points to consider in the development of classification and diagnostic criteria in systemic vasculitis. Ann Rheum Dis 2010;69:1744–50.

    Article  PubMed  Google Scholar 

  3. Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, de Groot K, Gross W, et al. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2009;68:318–23.

    Article  PubMed  CAS  Google Scholar 

  4. Salvarani C, Silingardi M, Ghirarduzzi A, Lo Scocco G, Macchioni P, Bajocchi G, et al. Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis? Ann Intern Med 2002;137:232–8.

    PubMed  Google Scholar 

  5. Blockmans D. Utility of imaging studies in assessment of vascular inflammation. Cleve Clin J Med 2002;69 Suppl 2:SII95–9.

    Article  PubMed  Google Scholar 

  6. Tso E, Flamm SD, White RD, Schvartzman PR, Mascha E, Hoffman GS. Takayasu arteritis: utility and limitations of magnetic resonance imaging in diagnosis and treatment. Arthritis Rheum 2002;46:1634–42.

    Article  PubMed  Google Scholar 

  7. Kissin EY, Merkel PA. Diagnostic imaging in Takayasu arteritis. Curr Opin Rheumatol 2004;16:31–7.

    Article  PubMed  Google Scholar 

  8. Seo P, Stone JH. Large-vessel vasculitis. Arthritis Rheum 2004;51:128–39.

    Article  PubMed  Google Scholar 

  9. Aschwanden M, Kesten F, Stern M, Thalhammer C, Walker UA, Tyndall A, et al. Vascular involvement in patients with giant cell arteritis determined by duplex sonography of 2x11 arterial regions. Ann Rheum Dis 2010;69:1356–9.

    Article  PubMed  Google Scholar 

  10. Weber WA, Grosu AL, Czernin J. Technology insight: advances in molecular imaging and an appraisal of PET/CT scanning. Nat Clin Pract Oncol 2008;5:160–70.

    Article  PubMed  CAS  Google Scholar 

  11. Ishimori T, Saga T, Mamede M, Kobayashi H, Higashi T, Nakamoto Y, et al. Increased (18)F-FDG uptake in a model of inflammation: concanavalin A-mediated lymphocyte activation. J Nucl Med 2002;43:658–63.

    PubMed  CAS  Google Scholar 

  12. Jones HA, Cadwallader KA, White JF, Uddin M, Peters AM, Chilvers ER. Dissociation between respiratory burst activity and deoxyglucose uptake in human neutrophil granulocytes: implications for interpretation of (18)F-FDG PET images. J Nucl Med 2002;43:652–7.

    PubMed  CAS  Google Scholar 

  13. Turlakow A, Yeung HW, Pui J, Macapinlac H, Liebovitz E, Rusch V, et al. Fludeoxyglucose positron emission tomography in the diagnosis of giant cell arteritis. Arch Intern Med 2001;161:1003–7.

    Article  PubMed  CAS  Google Scholar 

  14. Brodmann M, Lipp RW, Aigner R, Pilger E. Positron emission tomography reveals extended thoracic and abdominal peri-aortitis. Vasc Med 2003;8:127–8.

    Article  PubMed  CAS  Google Scholar 

  15. Hara M, Goodman PC, Leder RA. FDG-PET finding in early-phase Takayasu arteritis. J Comput Assist Tomogr 1999;23:16–8.

    Article  PubMed  CAS  Google Scholar 

  16. Blockmans D, Maes A, Stroobants S, Nuyts J, Bormans G, Knockaert D, et al. New arguments for a vasculitic nature of polymyalgia rheumatica using positron emission tomography. Rheumatology (Oxford) 1999;38:444–7.

    Article  CAS  Google Scholar 

  17. Meller J, Grabbe E, Becker W, Vosshenrich R. Value of F-18 FDG hybrid camera PET and MRI in early takayasu aortitis. Eur Radiol 2003;13:400–5.

    PubMed  CAS  Google Scholar 

  18. Blockmans D, de Ceuninck L, Vanderschueren S, Knockaert D, Mortelmans L, Bobbaers H. Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients. Arthritis Rheum 2006;55:131–7.

    Article  PubMed  Google Scholar 

  19. Meller J, Strutz F, Siefker U, Scheel A, Sahlmann CO, Lehmann K, et al. Early diagnosis and follow-up of aortitis with [(18)F]FDG PET and MRI. Eur J Nucl Med Mol Imaging 2003;30:730–6.

    Article  PubMed  CAS  Google Scholar 

  20. Walter MA, Melzer RA, Schindler C, Müller-Brand J, Tyndall A, Nitzsche EU. The value of [18F]FDG-PET in the diagnosis of large-vessel vasculitis and the assessment of activity and extent of disease. Eur J Nucl Med Mol Imaging 2005;32:674–81.

    Article  PubMed  Google Scholar 

  21. Webb M, Chambers A, AL-Nahhas A, Mason JC, Maudlin L, Rahman L, et al. The role of 18F-FDG PET in characterising disease activity in Takayasu arteritis. Eur J Nucl Med Mol Imaging 2004;31:627–34.

    Article  PubMed  Google Scholar 

  22. Blockmans D, Bley T, Schmidt W. Imaging for large-vessel vasculitis. Curr Opin Rheumatol 2009;21:19–28.

    Article  PubMed  Google Scholar 

  23. Henes JC, Müller M, Krieger J, Balletshofer B, Pfannenberg AC, Kanz L, et al. [18F] FDG-PET/CT as a new and sensitive imaging method for the diagnosis of large vessel vasculitis. Clin Exp Rheumatol 2008;26:S47–52.

    PubMed  CAS  Google Scholar 

  24. Walter MA. [(18)F]fluorodeoxyglucose PET in large vessel vasculitis. Radiol Clin North Am 2007;45:735–44. viii.

    Article  PubMed  Google Scholar 

  25. Scheel AK, Meller J, Vosshenrich R, Kohlhoff E, Siefker U, Müller GA, et al. Diagnosis and follow up of aortitis in the elderly. Ann Rheum Dis 2004;63:1507–10.

    Article  PubMed  CAS  Google Scholar 

  26. Blockmans D, Coudyzer W, Vanderschueren S, Stroobants S, Loeckx D, Heye S, et al. Relationship between fluorodeoxyglucose uptake in the large vessels and late aortic diameter in giant cell arteritis. Rheumatology (Oxford) 2008;47:1179–84.

    Article  CAS  Google Scholar 

  27. Spira D, Kötter I, Ernemann U, Balletshofer B, Pfannenberg CA, Fenchel M, et al. Imaging of primary and secondary inflammatory diseases involving large and medium-sized vessels and their potential mimics: a multitechnique approach. AJR Am J Roentgenol 2010;194:848–56.

    Article  PubMed  Google Scholar 

  28. Bleeker-Rovers CP, Bredie SJ, van der Meer JW, Corstens FH, Oyen WJ. Fluorine 18 fluorodeoxyglucose positron emission tomography in the diagnosis and follow-up of three patients with vasculitis. Am J Med 2004;116:50–3.

    Article  PubMed  Google Scholar 

  29. Iwabu M, Yamamoto Y, Dobashi H, Kameda T, Kittaka K, Nishiyama Y. F-18 FDG PET findings of Takayasu arteritis before and after immunosuppressive therapy. Clin Nucl Med 2008;33:872–3.

    Article  PubMed  Google Scholar 

  30. Miller MD, Ferris DG. Measurement of subjective phenomena in primary care research: the Visual Analogue Scale. Fam Pract Res J 1993;13:15–24.

    PubMed  CAS  Google Scholar 

  31. Brodmann M, Lipp RW, Passath A, Seinost G, Pabst E, Pilger E. The role of 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries. Rheumatology (Oxford) 2004;43:241–2.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors declare that they have no conflict of interest. Martin A. Walter gratefully acknowledges the support of the Swiss National Science Foundation. Matthias Briel and Heike Raatz are supported by santésuisse and the Gottfried and Julia Bangerter-Rhyner Foundation. Sergio Prieto-González and Maria C. Cid are supported by Ministerio de Ciencia e Innovacion (SAF 08/04328 and SAF 11/30073).

Author information

Authors and Affiliations

  1. Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031, Basel, Switzerland

    Martin Fuchs, Helmut Rasch, Scott Berg, Quinn K. T. Ng, Jan Müller-Brand & Martin A. Walter

  2. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland

    Matthias Briel & Heike Raatz

  3. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    Matthias Briel

  4. Department of Rheumatology, University Hospital Basel, Basel, Switzerland

    Thomas Daikeler & Alan Tyndall

  5. Vasculitis and Lupus Unit, Addenbrooke’s Hospital, Cambridge, UK

    David Jayne

  6. Department of Internal Medicine II, University Hospital Tübingen, Tübingen, Germany

    Ina Kötter

  7. Department of General Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium

    Daniel Blockmans

  8. Department of Systemic Autoimmune Diseases, Hospital Clínic, University of Barcelona, IDIBAPS, Villarroel 170, 08036-Barcelona, Spain

    Maria C. Cid & Sergio Prieto-González

  9. Department of Rheumatology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

    Peter Lamprecht

  10. Department of Rheumatology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy

    Carlo Salvarani

  11. 1st Department of Internal Medicine, Agios Dimitrios General Hospital, Thessaloniki, Greece

    Zaharenia Karageorgaki

  12. Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK

    Richard Watts

  13. Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK

    Raashid Luqmani

  14. Department of Rheumatology of Basle University, Felix Platter Spital, Basel, Switzerland

    Ulrich A. Walker

  15. Ipswich Hospital NHS Trust, Ipswich, IP4 5pD, UK

    Richard Watts

Authors
  1. Martin Fuchs
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  2. Matthias Briel
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  3. Thomas Daikeler
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  11. Daniel Blockmans
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  15. Carlo Salvarani
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  16. Zaharenia Karageorgaki
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  17. Richard Watts
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  19. Jan Müller-Brand
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  20. Alan Tyndall
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  21. Martin A. Walter
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Corresponding author

Correspondence to Martin A. Walter.

Appendix

Appendix

The detailed expert scoring results are presented in Fig. 6.

Fig. 6
figure 6

Waterfall diagram of the expert scoring results in controls and vasculitis patients without (a) and with the 18F-FDG PET results (b). The inter-observer agreement was higher with the 18F-FDG PET results (mean standard deviation 13.4) than without (mean standard deviation 19.5)

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Fuchs, M., Briel, M., Daikeler, T. et al. The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging 39, 344–353 (2012). https://doi.org/10.1007/s00259-011-1967-x

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  • DOI: https://doi.org/10.1007/s00259-011-1967-x

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