Nuklearmedizin 2021; 60(02): 156
DOI: 10.1055/s-0041-1726727
WIS-Vortrag
Herz und Entzündung

Evaluation of metabolically active volume in FDG PET/CT for diagnosis of giant cell arteritis in a retrospective study

J Siefert
1   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Nuklearmedizin, Berlin
,
J Rogasch
1   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Nuklearmedizin, Berlin
,
H Hupperts
1   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Nuklearmedizin, Berlin
,
F Feldhaus
1   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Nuklearmedizin, Berlin
,
J Kaufmann
1   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Nuklearmedizin, Berlin
,
GR Burmester
2   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Berlin
,
H Amthauer
1   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Nuklearmedizin, Berlin
,
U Schneider
2   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Berlin
,
C Furth
1   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Nuklearmedizin, Berlin
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Ziel/Aim F-18-FDG-PET/CT is used in diagnosis of giant cell arteritis (GCA). Due to a need for reproducible interpretation criteria, visual scores like the total vascular score (TVS) and PETVAS have been evaluated. However, underreporting in atypical disease patterns and regionally limited disease is to assume. The metabolically active volume (MAV) may be an objective, reproducible marker of inflammatory activity in GCA.

Methodik/Methods Retrospective analysis of 58 patients undergoing F-18-FDG-PET/CT for suspected GCA. TVS and PETVAS were determined by summation of visual FDG uptake from 0 to 3 in comparison to liver uptake and blood pool. MAV of the inflammatory vessel walls was delineated accordingly (carotid arteries, vertebral arteries, brachiocephalic trunk, aorta, subclavian arteries, axillary arteries, iliac arteries) using dedicated software. Threshold for delineation was the patient’s liver SUVmean.

Ergebnisse/Results According to the standard of reference (final clinical diagnosis), 27/58 patients were positive for GCA, while 31/58 patients had no evidence of vasculitis. Areas under the curve (AUC) were similar for MAV (0.86), PETVAS (0.86) and TVS (0.85; DeLong, each p>0.75). Optimal cut-offs for diagnostic accuracy were ≥5 ml for MAV, ≥10 for PETVAS, and ≥9 for TVS. Sensitivity was 82 %, 67 %, and 70 % for MAV, PETVAS, and TVS, while specificity was 81 %, 84 %, and 84 % for MAV, PETVAS, and TVS. Diagnostic accuracy was similar (McNemar’s test, each p>0.58). In true positive cases, MAV ranged from 5.7 to 420 ml, whereas the positive range in TVS and PETVAS is limited to 21 or 27, respectively.

Schlussfolgerungen/Conclusions MAV of the inflammatory vessel walls is not inferior to the established TVS or PETVAS in diagnosis of GCA. The much higher range of MAV in positive cases might allow for more differentiated risk stratification and therapy monitoring to distinguish active or residual disease in patients under therapy. However, this requires prospective studies with serial follow-up examinations.



Publication History

Article published online:
08 April 2021

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