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

European Journal of Nuclear Medicine and Molecular Imaging volume 39, pages 344–353 (2012)Cite this 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.

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Acknowledgements

The authors declare that they have no conflict of interest. Martin A. Walter gratefully acknowledges the support of the Swiss National Science Foundation. Matthias Briel and Heike Raatz are supported by santésuisse and the Gottfried and Julia Bangerter-Rhyner Foundation. Sergio Prieto-González and Maria C. Cid are supported by Ministerio de Ciencia e Innovacion (SAF 08/04328 and SAF 11/30073).

Author information

Affiliations

  1. Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031, Basel, Switzerland

    Martin Fuchs, Helmut Rasch, Scott Berg, Quinn K. T. Ng, Jan Müller-Brand & Martin A. Walter

  2. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland

    Matthias Briel & Heike Raatz

  3. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    Matthias Briel

  4. Department of Rheumatology, University Hospital Basel, Basel, Switzerland

    Thomas Daikeler & Alan Tyndall

  5. Vasculitis and Lupus Unit, Addenbrooke’s Hospital, Cambridge, UK

    David Jayne

  6. Department of Internal Medicine II, University Hospital Tübingen, Tübingen, Germany

    Ina Kötter

  7. Department of General Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium

    Daniel Blockmans

  8. Department of Systemic Autoimmune Diseases, Hospital Clínic, University of Barcelona, IDIBAPS, Villarroel 170, 08036-Barcelona, Spain

    Maria C. Cid & Sergio Prieto-González

  9. Department of Rheumatology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

    Peter Lamprecht

  10. Department of Rheumatology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy

    Carlo Salvarani

  11. 1st Department of Internal Medicine, Agios Dimitrios General Hospital, Thessaloniki, Greece

    Zaharenia Karageorgaki

  12. Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK

    Richard Watts

  13. Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK

    Raashid Luqmani

  14. Department of Rheumatology of Basle University, Felix Platter Spital, Basel, Switzerland

    Ulrich A. Walker

  15. Ipswich Hospital NHS Trust, Ipswich, IP4 5pD, UK

    Richard Watts

Authors
  1. Martin Fuchs
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  2. Matthias Briel
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  3. Thomas Daikeler
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  4. Ulrich A. Walker
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  6. Scott Berg
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  9. David Jayne
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  10. Ina Kötter
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  11. Daniel Blockmans
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  14. Peter Lamprecht
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  15. Carlo Salvarani
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  16. Zaharenia Karageorgaki
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  17. Richard Watts
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  18. Raashid Luqmani
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  19. Jan Müller-Brand
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  20. Alan Tyndall
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  21. Martin A. Walter
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Corresponding author

Correspondence to Martin A. Walter.

Appendix

Appendix

The detailed expert scoring results are presented in Fig. 6.

Fig. 6
figure 6

Waterfall diagram of the expert scoring results in controls and vasculitis patients without (a) and with the 18F-FDG PET results (b). The inter-observer agreement was higher with the 18F-FDG PET results (mean standard deviation 13.4) than without (mean standard deviation 19.5)

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Fuchs, M., Briel, M., Daikeler, T. et al. The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging 39, 344–353 (2012). https://doi.org/10.1007/s00259-011-1967-x

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  • DOI: https://doi.org/10.1007/s00259-011-1967-x

Keywords

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