18F‐Fluorodeoxyglucose–Positron Emission Tomography As an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients With Large Vessel Vasculitis

Arthritis and Rheumatology - Tập 70 Số 3 - Trang 439-449 - 2018
Peter C. Grayson1, Sara Alehashemi1, Armin A. Bagheri1, A. Cahid Civelek2, Thomas R. Cupps3, Mariana J. Kaplan1, Ashkan A. Malayeri2, Peter A. Merkel4, Elaine Novakovich1, David A. Bluemke2, Mark A. Ahlman2
1National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH Bethesda Maryland
2Radiology and Imaging Sciences NIH Bethesda Maryland
3Georgetown University, Washington, DC
4University of Pennsylvania, Philadelphia

Tóm tắt

ObjectiveTo assess the clinical value of18F‐fluorodeoxyglucose (FDG) positron emission tomography (PET) in a prospective cohort of patients with large vessel vasculitis (LVV) and comparator subjects.MethodsPatients with Takayasu arteritis and giant cell arteritis were studied, along with a comparator group consisting of patients with hyperlipidemia, patients with diseases that mimicLVV, and healthy controls. Participants underwent clinical evaluation andFDG‐PETimaging, and patients withLVVunderwent serial imaging at 6‐month intervals. We calculated sensitivity and specificity ofFDG‐PETinterpretation for distinguishing patients with clinically activeLVVfrom comparator subjects and from patients with disease in clinical remission. A qualitative summary score based on global arterialFDGuptake, thePETVascular Activity Score (PETVAS), was used to study associations between activity onPETscan and clinical characteristics and to predict relapse.ResultsA total of 170FDG‐PETscans were performed in 115 participants (56 patients withLVVand 59 comparator subjects).FDG‐PETdistinguished patients with clinically activeLVVfrom comparator subjects with a sensitivity of 85% (95% confidence interval [95%CI] 69, 94) and a specificity of 83% (95%CI71, 91).FDG‐PETscans were interpreted as active vasculitis in most patients withLVVin clinical remission (41 of 71 [58%]). Clinical disease activity status, disease duration, body mass index, and glucocorticoid use were independently associated with activity onPETscan. Among patients who underwentPETduring clinical remission, future clinical relapse was more common in patients with a highPETVASthan in those with a lowPETVAS(55% versus 11%;P = 0.03) over a median follow‐up period of 15 months.ConclusionFDG‐PETprovides information about vascular inflammation that is complementary to, and distinct from, clinical assessment inLVV.FDG‐PETscan activity during clinical remission was associated with future clinical relapse.

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Arthritis and Rheumatology

Tập 70 Số 3

439-449

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