Clinical Utility of C-Reactive Protein and White Blood Cell Count for Scheduling an [18F]FDG PET/CT in Patients with Giant Cell Arteritis

Konstanze V. Guggenberger; Marius L. Vogt; Steven P. Rowe; Takahiro Higuchi; Marc Schmalzing; Hans-Peter Tony; Andreas K. Buck; Thorsten A. Bley; Matthias Fröhlich; Rudolf A. Werner

doi:10.1055/a-1830-7767

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2022; 61(06): 425-432
DOI: 10.1055/a-1830-7767

Original Article

Clinical Utility of C-Reactive Protein and White Blood Cell Count for Scheduling an [18F]FDG PET/CT in Patients with Giant Cell Arteritis

Klinische Wertigkeit des C-reaktiven Proteins und Leukozyten für die Durchführung eines [18F]FDG PET/CTs bei Patienten mit Riesenzellarteriitis

Konstanze V. Guggenberger

¹Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany (Ringgold ID: RIN27207)

,

Marius L. Vogt

²Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany (Ringgold ID: RIN27207)

,

Steven P. Rowe

³The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA

,

Takahiro Higuchi

⁴Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany

,

Marc Schmalzing

⁵Department of Internal Medicine II, Rheumatology and Clinical Immunology, University Hospital Würzburg, Würzburg, Germany (Ringgold ID: RIN27207)

,

Hans-Peter Tony

⁵Department of Internal Medicine II, Rheumatology and Clinical Immunology, University Hospital Würzburg, Würzburg, Germany (Ringgold ID: RIN27207)

,

Andreas K. Buck

⁴Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany

,

Thorsten A. Bley

¹Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany (Ringgold ID: RIN27207)

,

Matthias Fröhlich‡

⁵Department of Internal Medicine II, Rheumatology and Clinical Immunology, University Hospital Würzburg, Würzburg, Germany (Ringgold ID: RIN27207)

,

Rudolf A. Werner‡

³The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA

⁴Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany

› Author Affiliations

Abstract

Objectives 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG) PET/CT can be utilized in patients with giant cell arteritis (GCA), but pretest probability of established laboratory marker such as C-reactive protein (CRP) and white blood cell count (WBC) has not been defined yet. We aimed to elucidate the clinical utility of CRP and WBC for scheduling an [¹⁸F]FDG scan.

Methods 18 treatment-naïve GCA patients and 14 GCA subjects with anti-inflammatory treatment (glucocorticoids or comparable drugs), who underwent [¹⁸F]FDG PET/CT and who had no other inflammatory disease at time of scan, were identified. A semi-quantitative analysis in 11 vessel segments was conducted, with averaged jugular vein, healthy liver and lung tissue (Target-to-background ratio [TBR]_{VJ/liver/lung}) serving as background. Derived TBR were then correlated with CRP and WBC at time of PET using Spearman’s correlation.

Results For all treatment-naïve patients, TBR_VJ was 2.3±1.1 (95%CI, 2.2–2.5), TBR_liver was 1.0±0.5 (95%CI, 0.9–1.0) and average TBR_lung was 6.3±3.6 (95%CI, 5.8–6.8). No significant correlation was noted for either CRP (TBR_VJ: R=–0.19; TBR_liver: R=–0.03; TBR_lung: R=–0.17; each P ≥ 0.44) or for WBC (TBR_VJ: R=–0.40; TBR_liver: R=–0.32; TBR_lung: R=–0.37; each P ≥ 0.10). Similar results were recorded for patients under treatment at time of PET. Again, no significant correlation was reached for either CRP (TBR_VJ: R=–0.17; TBR_liver: R=–0.28; TBR_lung: R=–0.09; each P ≥ 0.32) or WBC (TBR_VJ: R=–0.06; TBR_liver: R=–0.13; TBR_lung: R=0.06; each P ≥ 0.65).

Conclusions In GCA patients with and without anti-inflammatory treatment, CRP and WBC did not substantially correlate with TBR at time of scan. Given the rather limited pretest probability of those parameters, such laboratory values may have less diagnostic utility to order an [¹⁸F]FDG PET/CT.

Zusammenfassung

Ziel Die 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG)-PET/CT wird bei Patienten mit einer Riesenzellarteriitis (RZA) eingesetzt, wobei die Vortestwahrscheinlichkeit für etablierte Laborparameter wie dem C-reaktiven Protein (CRP) und weißen Blutkörperchen (WBC) noch nicht evaluiert wurde. In vorliegender Studie sollte daher die klinische Wertigkeit dieser Marker zur Planung eines [¹⁸F]FDG-PET/CTs eruiert werden.

Methoden 18 nicht und 14 therapierte RZA-Patienten (unter Glukokortikoiden oder vergleichbarer Medikation), die ein [¹⁸F]FDG-PET/CT erhalten hatten und keine andere inflammatorische Erkrankung aufwiesen, wurden eingeschlossen. Es wurde eine semiquantitative Analyse (11 Gefäßabschnitte) mit Vena jugularis (VJ), gesunder Leber und Lunge als Hintergrundgewebe durchgeführt. Die Target-to-Background-Ratio (TBR_{VJ/Leber/Lunge}) wurde mit CRP und WBC zum Zeitpunkt des PET korreliert (mittels Spearman-Korrelation).

Resultate In der nicht therapierten Kohorte war die TBR_VJ 2,3±1,1 (95%-KI 2,2–2,5). Die TBR_Leber war 1,0±0,5 (95%-KI 0,9–1,0) und die TBR_Lunge war 6,3±3,6 (95%-KI 5,8–6,8). Es zeigte sich keine signifikante Korrelation mit CRP (TBR_VJ: R=–0.19; TBR_Leber: R=–0.03; TBR_Lunge: R=–0.17; jeweils P ≥ 0.44) oder mit WBC (TBR_VJ: R=–0.40; TBR_Leber: R=–0.32; TBR_Lunge: R=–0.37; jeweils P ≥ 0.10). Dies verhielt sich entsprechend für die therapierte Kohorte. Es zeigte sich weder für CRP (TBR_VJ: R=–0.17; TBR_Leber: R=–0.28; TBR_Lunge: R=–0.09; jeweils P ≥ 0.32) noch für WBC (TBR_VJ: R=–0.06; TBR_Leber: R=–0.13; TBR_Lunge: R=0.06; jeweils P ≥ 0.65) eine signifikante Korrelation.

Schlussfolgerung Bei therapierten und nicht therapierten RZA-Patienten zeigte sich weder für CRP noch WBC eine signifikante Korrelation mit der TBR. Somit scheinen diese Laborwerte eher nicht für die Planung eines [¹⁸F]FDG-PET/CTs geeignet zu sein.

Schlüsselwörter

Großgefäßvaskulitis - Riesenzellarteriitis - [18F]FDG PET/CT - C-reaktives Protein - Weiße Blutkörperchen

Keywords

Large Vessel Vasculitis - Giant Cell Arteritis - [18F]FDG PET/CT - C-reactive protein - White blood cell count

Full Text

References

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