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

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

In: European Journal of Nuclear Medicine and Molecular Imaging, 2012, vol. 39, no. 2, p. 344-353

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    Title
    • The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis
    Author
    • Fuchs, Martin. Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031, Basel, Switzerland
    • Briel, Matthias. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
    • Daikeler, Thomas. Department of Rheumatology, University Hospital Basel, Basel, Switzerland
    • Walker, Ulrich. Department of Rheumatology of Basle University, Felix Platter Spital, Basel, Switzerland
    • Rasch, Helmut. Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031, Basel, Switzerland
    • Berg, Scott. Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031, Basel, Switzerland
    • Ng, Quinn. Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031, Basel, Switzerland
    • Raatz, Heike. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
    • Jayne, David. Vasculitis and Lupus Unit, Addenbrooke's Hospital, Cambridge, UK
    • Kötter, Ina. Department of Internal Medicine II, University Hospital Tübingen, Tübingen, Germany
    • Blockmans, Daniel. Department of General Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium
    • Cid, Maria. Department of Systemic Autoimmune Diseases, Hospital Clínic, University of Barcelona, IDIBAPS, Villarroel 170, 08036-Barcelona, Spain
    • Prieto-González, Sergio. Department of Systemic Autoimmune Diseases, Hospital Clínic, University of Barcelona, IDIBAPS, Villarroel 170, 08036-Barcelona, Spain
    • Lamprecht, Peter. Department of Rheumatology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
    • Salvarani, Carlo. Department of Rheumatology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
    • Karageorgaki, Zaharenia. 1st Department of Internal Medicine, Agios Dimitrios General Hospital, Thessaloniki, Greece
    • Watts, Richard. Norwich Medical School, University of East Anglia, Norwich Research Park, NR4 7TJ, Norwich, UK
    • Luqmani, Raashid. Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK
    • Müller-Brand, Jan. Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031, Basel, Switzerland
    • Tyndall, Alan. Department of Rheumatology, University Hospital Basel, Basel, Switzerland
    • Walter, Martin. Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031, Basel, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • European Journal of Nuclear Medicine and Molecular Imaging, 2012, vol. 39, no. 2, p. 344-353. Springer-Verlag
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:311903
    Summary
    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