Parameters related to a positive test result for FDG PET(/CT) for large vessel vasculitis: a multicenter retrospective study

Abstract

The purpose of this study was to identify clinical and laboratory parameters that may improve the effectiveness of the use of fluorodeoxyglucose positron emission tomography ((18)F-FDG PET)(/CT) for diagnosing large vessel vasculitis (LVV), and secondarily to assess the contribution of (18)F-FDG PET/CT in finding other diagnoses for patients without signs of LVV on the scan. A multicenter retrospective study of (18)F-FDG PET(/CT) scans performed between January 2000 and December 2009 for clinical suspicion of LVV was conducted. A total of 304 (18)F-FDG PET(/CT) scans were included, of which 62 (20%) were positive and 242 (80%) were negative for LVV. Univariate analysis showed that patients with a positive scan were older (65.9 ± 13.4 versus 58.6 ± 16.5 years, p = 0.002), were more frequently female (76% versus 55%, p = 0.002), more often had a history of temporal arteritis (10% versus 3%, p = 0.044), less frequently had artralgia (31% versus 67%, p = 0.000), and had higher thrombocyte counts (434 ± 161 versus 373 ± 168 × 10(9)/l, p = 0.049) and a higher erythrocyte sedimentation rate (ESR) (72.6 ± 31.0 versus 51.4 ± 30.5 mm/h, p = 0.001) than patients with a negative scan. In the multivariate analysis, only artralgia (OR 0.091; 95% CI 0.023-0.366) and ESR (OR 1.024; 95% CI 1.002-1.046) remained statistically significant predictors. The presence of artralgia is a statistically significant negative predictor and an elevated ESR a statistically significant positive predictor of LVV showing up on (18)F-FDG PET(/CT). A reliable prediction of the outcome of the scan, based on these two parameters, is not possible however. (18)F-FDG PET(/CT) allows early diagnosis of LVV and may discover occult inflammatory or neoplastic disorders.

The predictive value of C-reactive protein and erythrocyte sedimentation rate for 18F-FDG PET/CT outcome in patients with fever and inflammation of unknown origin

“…Inflammation of unknown origin (IUO), without fever, and fever of unknown origin (FUO) may represent different clinical presentations of the same underlying disease [1]. This concept was supported in five recent studies [2]. These studies showed that the diagnostic yield, the distribution in categories of the underlying etiologies (i.e.…”

Role of 18F-FDG PET-CT in Vasculitis: a Prospective Study

“…As reported by Hooisma (2012), the diagnostic standard method for LVV, especially in giant cell arteritis (GCA), is a temporal artery biopsy, but the test results can be false negative in 15-70%, which may delay the diagnosis; in Takayasu's arteritis (TA), which affects the aorta and its main branches, as well as the coronary and pulmonary arteries, routine histological examination is not suitable. Besson and coworkers (2011) reported in their meta-analysis that diagnostic performance of FDG-PET in giant cell arteritis provided sensitivity and specificity of 80% and 89%, respectively.…”

“…In their study, Ergul (2011) and Hooisma (2012) highlighted the utility of PET in early diagnosis of LVV and in discovery of occult inflammatory or neoplastic disorders.…”

Reassessing classification criteria for Takayasu arteritis: Comment on the article by Lee et al

“…Ethnicity is an important risk factor for GCA, with the highest incidence found among people of Scandinavian origin (6). GCA is rare in people of Asian descent, and to date only a few cases have been reported in South Korea (7)(8)(9)(10). In contrast, TA seems to be more prevalent in Asian countries compared to Western countries.…”

“…Third, large vessel involvement in GCA may occur without involvement of the temporal arteries. In a recent series it was found that half of patients with increased 18 F-FDG uptake in the thoracic aorta and its main branches, which was suggestive of GCA, had positive temporal artery biopsy results (9).…”