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A retrospective cohort study to assess PET-CT findings and clinical outcomes in Takayasu arteritis: does 18F-fluorodeoxyglucose uptake in arteries predict relapses?

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Abstract

The objective of this study is to investigate the use of PET-CT scan with 18F-fluorodeoxyglucose (18F-FDG) as a method to predict outcomes in patients with Takayasu arteritis (TAK), as well as to analyze associations between 18F-FDG PET-CT findings with disease relapses, sustained remission, new angiographic lesions, ischemic events, and changes in therapy for TAK. At baseline assessment, 36 TAK patients underwent 18F-FDG PET-CT scan and maximal standardized uptake value (SUVmax) in arteries ≥ 1.3 was predictive for clinical disease activity. Thirty-two TAK patients were then followed-up for a median 83.5 months. Twenty-three (71.9%) patients developed clinical relapses and new arterial lesions were observed in 14 (43.8%) cases. Disease relapses [85.0% vs. 50.0%, p = 0.049; odds ratio (OR): 5.667; 95% confidence interval (95 CI): 1.067–30.085] and the need for changing immunosuppressive therapy (85.0% vs. 41.7%, p = 0.018; OR: 7.933; 95CI: 1.478–42.581) were more frequently found in patients with SUVmax ≥ 1.3 at baseline compared with those presenting SUVmax < 1.3. No associations were found between SUVmax ≥ or < 1.3 in large arteries at baseline and the development of ischemic events, sustained remission or new angiographic lesions. In multivariate analysis, associations between baseline SUVmax ≥ 1.3 and disease relapses were not independent (hazard ratio: 1.07; 95 CI 0.39–2.92; p = 0.892). In conclusion, arterial SUVmax is marginally associated with disease relapses and with the need to change therapy in TAK. 18F-FDG uptake in large arteries is not associated with the development of new arterial lesions in TAK.

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Acknowledgements

The authors thank Henrique A. Mariz, Neusa P. Silva, Ivone C. G. Torres, Paula N. V. Pinto and Eduardo N. P. Lima for their contribution for the development of this study.

Funding

This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Grant Numbers 2008/54787-3 and 2015-16020/6.

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Authors and Affiliations

  1. Rheumatology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 740 3° andar, São Paulo, SP, 04023-900, Brazil

    Anna Larissa Faria Janes, Míriam Fang Castro, Anne Elizabeth Diniz Arraes, Bruna Savioli, Emília Inoue Sato & Alexandre W. S. de Souza

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  1. Anna Larissa Faria Janes
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  2. Míriam Fang Castro
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Contributions

ALFJ contributed to the study design, and to the acquisition of data, analyzed and interpreted data, drafted the manuscript, and gave approval to the final version of the manuscript. MFC contributed to the to the acquisition of data, interpreted data for the work, revised critically the manuscript for important intellectual content, and gave approval to the final version of the manuscript. AEDA contributed to the to the acquisition of data, revised critically the manuscript for important intellectual content, and gave approval to the final version of the manuscript. BS contributed to the to the acquisition of data, interpreted data for the work, revised critically the manuscript for important intellectual content, and gave approval to the final version of the manuscript. EIS contributed to the study design, interpreted data for the work, revised critically the manuscript for important intellectual content, and gave approval to the final version of the manuscript. AWSS contributed to the study design, analyzed data, revised critically the manuscript for important intellectual content, and gave approval to the final version of the manuscript. All authors agree to be accountable for all aspects of the article as the ensure that questions regarding its accuracy or integrity will be promptly investigated and resolved.

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Correspondence to Alexandre W. S. de Souza.

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The authors A.L.F.J., M.F.C., A.E.D.A., B.S., and E.I.S. declare that they have no conflicts of interests. Author A.W.S.S. received a speaker honorarium from Roche.

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This study was published as congress abstract in Refs. [47, 48].

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Janes, A.L.F., Castro, M.F., Arraes, A.E.D. et al. A retrospective cohort study to assess PET-CT findings and clinical outcomes in Takayasu arteritis: does 18F-fluorodeoxyglucose uptake in arteries predict relapses?. Rheumatol Int 40, 1123–1131 (2020). https://doi.org/10.1007/s00296-020-04551-2

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