The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis

  • Martin Fuchs
  • Matthias Briel
  • Thomas Daikeler
  • Ulrich A. Walker
  • Helmut Rasch
  • Scott Berg
  • Quinn K. T. Ng
  • Heike Raatz
  • David Jayne
  • Ina Kötter
  • Daniel Blockmans
  • Maria C. Cid
  • Sergio Prieto-González
  • Peter Lamprecht
  • Carlo Salvarani
  • Zaharenia Karageorgaki
  • Richard Watts
  • Raashid Luqmani
  • Jan Müller-Brand
  • Alan Tyndall
  • Martin A. Walter
Original Article

Abstract

Purpose

We aimed to assess the impact of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the management of patients with suspected large vessel vasculitis.

Methods

An international expert panel determined diagnoses and clinical management in patients with suspected large vessel vasculitis, with and without the results of 18F-FDG PET, respectively. The accuracy of the clinical diagnosis and the resulting clinical management with and without the 18F-FDG PET results were compared using logistic regression models.

Results

The analysis included 30 patients referred to a tertiary care centre with large vessel vasculitis and 31 controls. 18F-FDG PET had an overall sensitivity of 73.3% [95% confidence interval (CI) 54.1–87.7%], a specificity of 83.9% (95% CI 66.3–94.5%), a positive predictive value of 81.5% (95% CI 61.9–93.7%) and a negative predictive value of 76.5% (95% CI 58.8–89.3%). The diagnostic accuracy of 18F-FDG PET was higher in patients not receiving immunosuppressive drugs (93.3 vs 64.5%, p = 0.006). Taken in context with other available diagnostic modalities, the addition of 18F-FDG PET increased the clinical diagnostic accuracy from 54.1 to 70.5% (p = 0.04). The addition of 18F-FDG PET increased the number of indicated biopsies from 22 of 61 patients (36.1%) to 25 of 61 patients (41.0%) and changed the treatment recommendation in 8 of 30 patients (26.7%) not receiving immunosuppressive medication and in 7 of 31 patients (22.6%) receiving immunosuppressive medication.

Conclusion

18F-FDG PET is a sensitive and specific imaging tool for large vessel vasculitis, especially when performed in patients not receiving immunosuppressive drugs. It increases the overall diagnostic accuracy and has an impact on the clinical management in a significant proportion of patients.

Keywords

Positron emission tomography Fluorodeoxyglucose Giant cell arteritis Takayasu’s arteritis Immunosuppressive drugs 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Martin Fuchs
    • 1
  • Matthias Briel
    • 2
    • 3
  • Thomas Daikeler
    • 4
  • Ulrich A. Walker
    • 14
  • Helmut Rasch
    • 1
  • Scott Berg
    • 1
  • Quinn K. T. Ng
    • 1
  • Heike Raatz
    • 2
  • David Jayne
    • 5
  • Ina Kötter
    • 6
  • Daniel Blockmans
    • 7
  • Maria C. Cid
    • 8
  • Sergio Prieto-González
    • 8
  • Peter Lamprecht
    • 9
  • Carlo Salvarani
    • 10
  • Zaharenia Karageorgaki
    • 11
  • Richard Watts
    • 12
    • 15
  • Raashid Luqmani
    • 13
  • Jan Müller-Brand
    • 1
  • Alan Tyndall
    • 4
  • Martin A. Walter
    • 1
  1. 1.Institute of Nuclear MedicineUniversity HospitalBaselSwitzerland
  2. 2.Basel Institute for Clinical Epidemiology and BiostatisticsUniversity Hospital BaselBaselSwitzerland
  3. 3.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  4. 4.Department of RheumatologyUniversity Hospital BaselBaselSwitzerland
  5. 5.Vasculitis and Lupus UnitAddenbrooke’s HospitalCambridgeUK
  6. 6.Department of Internal Medicine IIUniversity Hospital TübingenTübingenGermany
  7. 7.Department of General Internal MedicineUniversity Hospital GasthuisbergLeuvenBelgium
  8. 8.Department of Systemic Autoimmune DiseasesHospital Clínic, University of Barcelona, IDIBAPS08036-BarcelonaSpain
  9. 9.Department of RheumatologyUniversity Hospital of Schleswig-HolsteinLübeckGermany
  10. 10.Department of RheumatologyArcispedale S. Maria NuovaReggio EmiliaItaly
  11. 11.1st Department of Internal MedicineAgios Dimitrios General HospitalThessalonikiGreece
  12. 12.Norwich Medical SchoolUniversity of East AngliaNorwichUK
  13. 13.Department of RheumatologyNuffield Orthopaedic CentreOxfordUK
  14. 14.Department of Rheumatology of Basle UniversityFelix Platter SpitalBaselSwitzerland
  15. 15.Ipswich Hospital NHS TrustIpswichUK

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