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Diagnostic performance of 18F-FDG PET-CT for large vessel involvement assessment in patients with suspected giant cell arteritis and negative temporal artery biopsy

  • Boramy HayEmail author
  • Denis Mariano-Goulart
  • Aurélie Bourdon
  • Meriem Benkiran
  • Fabien Vauchot
  • Delphine De Verbizier
  • Fayçal Ben Bouallègue
Original Article
  • 44 Downloads

Abstract

Objective

The purpose of our study was to assess the diagnostic performance of 18F-FDG PET-CT for large vessel involvement in patients with suspected giant cells arteritis (GCA) and a negative temporal artery biopsy (TAB).

Methods

We conducted a retrospective study in a cohort of patients with suspected GCA and negative TAB who underwent an 18F-FDG PET-CT. Ten vascular segments were studied using a visual score and a semi-quantitative method based on SUVmax ratio with respect to liver uptake. The diagnosis of GCA was established during a mean follow-up of 42 months, based on the presence of clinical symptoms, laboratory results, and imaging data compatible with GCA, good response to corticosteroid therapy, and no differential diagnosis after a follow-up of at least 18 months.

Results

We included 63 patients (30 men and 33 women, aged 67 ± 12 years). 18F-FDG PET-CT showed large vessel involvement in 22 patients, 14 of whom were finally diagnosed with GCA. Forty-one patients were 18F-FDG PET-CT negative, 9 of whom were finally diagnosed with GCA. Overall, 18F-FDG uptake by large vessel yielded 61% sensitivity, 80% specificity, 64% positive predictive value, 78% negative predictive value, and 73% diagnostic accuracy. A significant number of patients were treated by corticosteroids before 18F-FDG PET-CT. However, corticosteroid therapy did not impact significantly the diagnostic performance, although there was a trend to a lower sensitivity in patients receiving corticosteroid therapy for more than 3 days.

Conclusions

18F-FDG PET-CT is a useful imaging technique to assess large vessel involvement in patients with suspected GCA and negative TAB.

Keywords

18F-FDG PET-CT Giant cell arteritis Temporal artery biopsy Large vessel vasculitis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflicts of interest and no funding was received for this study.

References

  1. 1.
    Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 Revised international chapel hill consensus conference nomenclature of vasculitides. Arthritis Rheum. 2013;65:1–11.CrossRefGoogle Scholar
  2. 2.
    González-Gay MA, García-Porrua C, Llorca J, Gonzalez-Louzano C, Rodriguez- Ledo P. Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy. Semin Arthritis Rheum. 2001;30:249–56.CrossRefGoogle Scholar
  3. 3.
    Roth AM, Milsow L, Keltner JL. The ultimate diagnoses of patients undergoing temporal artery biopsies. Arch Ophtalmol. 1984;102:901–3.CrossRefGoogle Scholar
  4. 4.
    Brack A, Martinez-Taboada V, Stanson A, Goronzy JJ, Weyand CM. Disease pattern in cranial and large-vessel giant cell arteritis. Arthritis Rheum. 1999;42:311–7.CrossRefGoogle Scholar
  5. 5.
    Ozaki S, Ando M, Isobe M, Kobayashi S, Matsunaga N, Miyata T, et al. Guideline for management of vasculitis syndrome (JCS 2008). Japanese Circulation Society. Circ J. 2011;75:474–503.CrossRefGoogle Scholar
  6. 6.
    Dejaco C, Ramiro S, Duftner C, Besson FL, Bley TA, Blockmans D, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis. 2018;77:636–43.CrossRefGoogle Scholar
  7. 7.
    Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990;33:1122–8.CrossRefGoogle Scholar
  8. 8.
    Prieto-González S, Arguis P, García-Martínez A, Espígol-Frigolé G, Tavera-Bahillo I, Butjosa M, et al. Large vessel involvement in biopsy-proven giant cell arteritis: prospective study in 40 newly diagnosed patients using CT angiography. Ann Rheum Dis. 2012;71:1170–6.CrossRefGoogle Scholar
  9. 9.
    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;15(55):131–7.CrossRefGoogle Scholar
  10. 10.
    De Boysson H, Lambert M, Liozon E, Boutemy J, Maigné G, Ollivier Y, et al. Giant-cell arteritis without cranial manifestations: working diagnosis of a distinct disease pattern. Medicine (Baltimore). 2016;95:e3818.CrossRefGoogle Scholar
  11. 11.
    Ninan J, Lester S, Hill C. Giant cell arteritis. Best Pract Res Clin Rheumatol. 2016;30:169–88.CrossRefGoogle Scholar
  12. 12.
    Soussan M, Nicolas P, Schramm C, Katsahian S, Pop G, Fain O, et al. Management of large-vessel vasculitis with FDG-PET: a systematic literature review and meta-analysis. Medicine (Baltimore). 2015;94:e622.CrossRefGoogle Scholar
  13. 13.
    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.CrossRefGoogle Scholar
  14. 14.
    Slart RHJA, Glaudemans AWJM, Chareonthaitawee P, Treglia G, Besson FL, Bley TA, et al. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging. 2018;45:1250–69.CrossRefGoogle Scholar
  15. 15.
    Besson FL, de Boysson H, Parienti JJ, Bouvard G, Bienvenu B, Agostini D. Towards an optimal semiquantitative approach in giant cell arteritis: an (18)F-FDG PET/CT case-control study. Eur J Nucl Med Mol Imaging. 2014;41:155–66.CrossRefGoogle Scholar
  16. 16.
    Borchers AT, Gershwin ME. Giant cell arteritis: a review of classification, pathophysiology, geoepidemiology and treatment. Autoimmun Rev. 2012;11:A544–54.CrossRefGoogle Scholar
  17. 17.
    Mahr A, Saba M, Kambouchner M, Polivka M, Baudrimont M, Brochériou I, et al. Temporal artery biopsy for diagnosing giant cell arteritis: the longer, the better? Ann Rheum Dis. 2006;65:826–8.CrossRefGoogle Scholar
  18. 18.
    Boyev LR, Miller NR, Green WR. Efficacy of unilateral versus bilateral temporal artery biopsies for the diagnosis of giant cell arteritis. Am J Ophthalmol. 1999;128:211–5.CrossRefGoogle Scholar
  19. 19.
    Narváez J, Bernad B, Roig-Vilaseca D, García-Gómez C, Gómez-Vaquero C, Juanola X, et al. Influence of previous corticosteroid therapy on temporal artery biopsy yield in giant cell arteritis. Semin Arthritis Rheum. 2007;37:13–9.CrossRefGoogle Scholar
  20. 20.
    Muratore F, Kermani TA, Crowson CS, Green AB, Salvarani C, Eric L, et al. Large-vessel giant cell arteritis: a cohort study. Rheumatology (Oxford). 2015;54:463–70.CrossRefGoogle Scholar
  21. 21.
    Murchison AP, Gilbert ME, Bilyk JR, Eagle RC, Pueyo V, Sergott RC, et al. Validity of the American College of Rheumatology criteria for the diagnosis of giant cell arteritis. Am J Ophthalmol. 2012;154:722–9.CrossRefGoogle Scholar
  22. 22.
    Ostberg G. Temporal arteritis in a large necropsy series. Ann Rheum Dis. 1971;30:224–35.CrossRefGoogle Scholar
  23. 23.
    Rojo-Leyva F, Ratliff NB, Cosgrove DM, Hoffman GS. Study of 52 patients with idiopathic aortitis from a cohort of 1204 surgical cases. Arthritis Rheum. 2000;43:901–7.CrossRefGoogle Scholar
  24. 24.
    Hernandez-Rodriguez J, Garcia-Martinez A, Espigol-Frigole G, Grau JM, Collado A, Cid MC. Sustained spontaneous clinical remission in giant cell arteritis: report of two cases with long-term follow up. Arthritis Rheum. 2006;55:160–2.CrossRefGoogle Scholar
  25. 25.
    Purvin V, Kawasaki A. Giant cell arteritis with spontaneous remission. Clin Exp Ophthalmol. 2007;35:59–61.CrossRefGoogle Scholar
  26. 26.
    Puppo C, Massollo M, Paparo F, Camellino D, Piccardo A, Shoushtari Zadeh Naseri M, et al. Giant cell arteritis: a systematic review of the qualitative and semiquantitative methods to assess vasculitis with 18F-fluorodeoxyglucose positron emission tomography. Biomed Res Int. 2014;2014:574248.CrossRefGoogle Scholar
  27. 27.
    Besson FL, Parienti JJ, Bienvenu B, Prior JO, Costo S, Bouvard G, et al. Diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2011;38:1764–72.CrossRefGoogle Scholar
  28. 28.
    Fuchs M, Briel M, Daikeler T, Walker UA, Rasch H, Berg S, et al. The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging. 2012;39:344–53.CrossRefGoogle Scholar
  29. 29.
    Nielsen BD, Gormsen LC, Hansen IT, Keller KK, Therkildsen P, Hauge EM. Three days of high-dose glucocorticoid treatment attenuates large-vessel 18F-FDG uptake in large-vessel giant cell arteritis but with a limited impact on diagnostic accuracy. Eur J Nucl Med Mol Imaging. 2018;45:1119–28.CrossRefGoogle Scholar
  30. 30.
    De Boysson H, Liozon E, Lambert M, Parienti JJ, Artigues N, Geffray L, et al. 18F-fluorodeoxyglucose positron emission tomography and the risk of subsequent aortic complications in giant-cell arteritis A multicenter cohort of 130 patients. Medicine (Baltimore). 2016;95:e3851.CrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2019

Authors and Affiliations

  1. 1.Nuclear Medicine DepartmentMontpellier University HospitalMontpellierFrance
  2. 2.PhyMedExp, INSERM – CNRS, Montpellier UniversityMontpellierFrance

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