The role of ultrasound and FDG-PET/CT to detect extracranial artery involvement in patients with suspected large vessel vasculitis

Abstract

Objective To assess the accuracy of ultrasound (US) versus FDG-PET/CT to identify extracranial involvement in suspected large vessel vasculitis (LVV) patients. Methods Retrospective observational study of patients referred to our US fast track clinic with suspected LVV. All patients underwent US exam within 24 hours per protocol. FDG-PET/CT was performed according to clinician criteria. The gold standard for LVV diagnosis was clinical confirmation after 6 months. Results Of the 113 patients included (74.3% female, mean age 74 years), 37(32.7%) were diagnosed of LVV after 6 months. Sensitivity and specificity of US was 86.5% and 96.1%, respectively (85.7% and 87.1% for intracranial and 94.1% and 80.2% for extracanial arteries, respectively). Only 12(42.9%) of 28 patients undergoing a FDG-PET/CT per clinician criteria, showed positive findings. Sensitivity and specificity of FDG-PET/CT for LVV was 61.1% and 90%, respectively (55.6% and 63.2% for intracranial and 84.6% and 93.3% for extacranial arteries). Taking FDG-PET/CT as the reference, US showed extracranial inflammation in 10/12(83.3%) and detected 2(12.5%) additional cases of extracranial involvement with negative FDG-PET/CT. Conversely, FDG-PET/CT showed extracranial inflammation in 2 patients with negative US (1 isolated aortitis and 1 aortoiliac involvement). FDG-PET/CT showed cranial artery uptake in none of patients. Conclusions US and FDG-PET/CT are both valid tools to detect extracranial involvement. Presence of US extracranial artery inflammation is consistent with FDG-PET/CT examination, although a negative US scan does not rule out extracranial involvement. Our data support the use of US as first-line investigation in patients suspected of cranial, but also extracranial LVV.

Performance of the 2022 ACR/EULAR giant cell arteritis classification criteria for diagnosis in patients with suspected giant cell arteritis in routine clinical care

“…Nowadays, vascular imaging modalities have increasingly been incorporated into patient assessments; indeed, in more than half of suspected GCA cases showing LV-GCA. [3][4][5][6] Moreover, EULAR recommendations place ultrasound (US) of temporal (TA) and axillary arteries as first-line imaging tests and a non-compressible halo sign may replace the need for TAB in patients with high pretest probability. 7 Newer randomised controlled trials have applied additional inclusion criteria for patients with GCA such as polymyalgia rheumatica, C reactive protein (CRP) or imaging (US, fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT, MRI or CT) [8][9][10][11] and TAB has been replaced by imaging as the first-line diagnostic test in patients with suspected GCA in clinical practice.…”

Impact of ultrasound limitation to assess aortitis in patients with giant cell arteritis: comparative study with FDG-PET/CT

“…Several studies have compared the ability of US and FDG-PET/CT to detect LV-GCA, showing good, but not excellent agreement between both techniques. 4 18–20 However, for most studies comparing different imaging tools, the patients included are usually investigated based on either clinical or imaging findings of LV-GCA, which could potentially lead to circularity. To our knowledge, no studies have been specifically designed to assess the added value of FDG-PET/CT in patients with GCA and positive US findings.…”

Osteoimmunology: The Crosstalk between T Cells, B Cells, and Osteoclasts in Rheumatoid Arthritis

“…Romosozumab is a humanized monoclonal antibody that binds with and inhibits sclerostin through Wnt signaling, resulting in a dual effect of increasing bone formation while decreasing bone resorption [ 163 ]. In the findings of a randomized clinical pilot study, romosozumab treatment was demonstrated to be more effective than denosumab in enhancing lumbar spine BMD, potentially rendering it a viable option for patients who require a significant increase in lumbar spine BMD and are at a higher risk of fractures [ 164 ]. In patients with RA, no discernible difference in disease activity or joint damage was observed between romosozumab and denosumab treatments.…”

“…However, there have been reports in the literature suggesting that romosozumab treatment may have adverse effects on disease activity and joint damage in RA patients. Nonetheless, it is worth noting that romosozumab treatment may not affect disease activity and joint damage in RA patients whose condition is relatively well-controlled [ 164 ].…”