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

Abstract

Large vessel vasculitis (LVV) is defined as a disease mainly affecting the large arteries, with two major variants, Takayasu arteritis (TA) and giant cell arteritis (GCA). GCA often coexists with polymyalgia rheumatica (PMR) in the same patient, since both belong to the same disease spectrum. FDG-PET/CT is a functional imaging technique which is an established tool in oncology, and has also demonstrated a role in the field of inflammatory diseases. Functional FDG-PET combined with anatomical CT angiography, FDG-PET/CT(A), may be of synergistic value for optimal diagnosis, monitoring of disease activity, and evaluating damage progression in LVV. There are currently no guidelines regarding PET imaging acquisition for LVV and PMR, even though standardization is of the utmost importance in order to facilitate clinical studies and for daily clinical practice. This work constitutes a joint procedural recommendation on FDG-PET/CT(A) imaging in large vessel vasculitis (LVV) and PMR from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine (EANM), the Cardiovascular Council of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), and the PET Interest Group (PIG), and endorsed by the American Society of Nuclear Cardiology (ASNC). The aim of this joint paper is to provide recommendations and statements, based on the available evidence in the literature and consensus of experts in the field, for patient preparation, and FDG-PET/CT(A) acquisition and interpretation for the diagnosis and follow-up of patients with suspected or diagnosed LVV and/or PMR. This position paper aims to set an internationally accepted standard for FDG-PET/CT(A) imaging and reporting of LVV and PMR.Electronic supplementary materialThe online version of this article (10.1007/s00259-018-3973-8) contains supplementary material, which is available to authorized users.

Diagnostic accuracy of positron emission tomography for assessment of disease activity in large vessel vasculitis

“…There is general consensus that PET/CT is the diagnostic reference standard in the diagnosis of LVV involving the extracranial large‐ and medium‐sized arteries . A recent meta‐analysis calculated a sensitivity and specificity of PET/CT with visual rating of arterial tracer uptake in relation to liver uptake for detection of extracranial large vessel inflammation in GCA of 90% and 98% .…”

“…Uptake of the aortic wall was compared to the liver uptake utilizing an established semiquantitative 4‐point visual score: 3, aortic wall uptake higher than liver uptake; 2, aortic wall uptake similar to liver uptake; 1, aortic wall uptake lower than liver uptake; 0, no aortic wall uptake . Scores 2 and 3 were graded as active disease.…”

“…Noninvasive vascular imaging has become standard in the diagnosis of LVV and has uncovered the high frequency of extracranial large artery involvement in GCA . Among all imaging modalities available, 18 F‐fluorodeoxyglucose ( 18 F‐FDG) positron emission tomography (PET) can be considered the diagnostic reference standard for detection of inflammation of the extracranial large arteries . Moreover, as clinical judgement of disease activity under immunosuppressive treatment is challenging, PET is commonly used during follow up in order to monitor vascular inflammation.…”

Systemic Vasculitis With Lesion of Large Vessels as a Cause of Art Erial Hypert Ension in a Patient of Young Age

“…Одним из наиболее перспективных методов ин-струментальной диагностики является ПЭТ-КТ, кото-рая позволяет наиболее точно оценить сосудистое воспаление [19,20]. Данный неинвазивный метод позволяет с высокой информативностью обнаружить очаги гранулематозного воспаления сосудов, что мо-жет иметь принципиальное значение для определения показаний к иммуносупрессивному лечению.…”

Clinical Applicability of Ultrasound in Systemic Large Vessel Vasculitides

“…In recent years, metabolic imaging with PET‐CT has become a promising tool in the assessment of large vessel vasculitis . While its application is not recommended on the cranial arteries , there is, however, agreement on its usage in the diagnosis of large extracranial vessel vasculitis . Soussan et al conducted a review and meta‐analysis of the implementation of PET‐CT in the diagnosis of GCA, which showed 89.5% sensitivity and 97.7% specificity .…”