Cranial and large vessel activity on positron emission tomography scan at diagnosis and 6 months in giant cell arteritis

Sammel, Anthony M.; Hsiao, Edward; Schembri, Geoffrey; Nguyen, Katherine; Brewer, Janice; Schrieber, Leslie; Janssen, Beatrice; Youssef, Peter; Fraser, Clare L.; Laurent, R

doi:10.1111/1756-185x.13805

Cited by 27 publications

(18 citation statements)

References 20 publications

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“…A further 42 articles were excluded following fulltext assessment. Eventually, 21 studies were selected for the qualitative analysis (systematic review) [16,17,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Eight studies were included in the meta-analysis since these reports contained sufficient data to either evaluate the accuracy of [18F]FDG-PET/CT for discriminating between active disease and remission during treatment [19,23,25,33] or to evaluate the proportion of patients in which the scan normalized during clinical remission in patients on treatment [17,20,22,36].…”

Section: Literature Searchmentioning

confidence: 99%

Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis

Geest

Treglia

Glaudemans

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose Monitoring disease activity in patients with large vessel vasculitis (LVV) can be challenging. [18F]FDG-PET/CT is increasingly used to evaluate treatment response in LVV. In this systematic review and meta-analysis, we aimed to summarize the current evidence on the value of [18F]FDG-PET/CT for treatment monitoring in LVV. Methods PubMed/MEDLINE and the Cochrane library database were searched from inception through October 21, 2020. Studies containing patients with LVV (i.e. giant cell arteritis, Takayasu arteritis and isolated aortitis) that received treatment and underwent [18F]FDG-PET/CT were included. Screening, full-text review and data extraction were performed by 2 investigators. The risk of bias was examined with the QUADAS-2 tool. Meta-analysis of proportions and diagnostic test accuracy was performed by a random-effects model and bivariate model, respectively. Results Twenty-one studies were included in the systematic review, of which 8 studies were eligible for meta-analysis. Arterial [18F]FDG uptake decreased upon clinical remission in longitudinal studies. High heterogeneity (I2 statistic 94%) precluded meta-analysis of the proportion of patients in which the scan normalized during clinical remission. Meta-analysis of cross-sectional studies indicated that [18F]FDG-PET/CT may detect relapsing/refractory disease with a sensitivity of 77% (95%CI 57–90%) and specificity of 71% (95%CI 47–87%). Substantial heterogeneity was observed among the cross-sectional studies. Both variation in clinical aspects and imaging procedures contributed to the heterogeneity. Conclusion Treatment of LVV leads to reduction of arterial [18F]FDG uptake during clinical remission. [18F]FDG-PET/CT has moderate diagnostic accuracy for detecting active LVV. [18F]FDG-PET/CT may aid treatment monitoring in LVV, but its findings should be interpreted in the context of the clinical suspicion of disease activity. This study underlines the relevance of published procedural recommendations for the use of [18F]FDG-PET/CT in LVV.

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Section: Literature Searchmentioning

confidence: 99%

Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis

Geest

Treglia

Glaudemans

et al. 2021

Eur J Nucl Med Mol Imaging

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“…These patients were treated with glucocorticoids and, some of them, with immunosuppressive drugs. In this line, Sammel et al (26) reported persistence of grade 2 vascular uptake in at least one vascular territory in 5 of the 15 (33%) patients with GCA treated with glucocorticoids and immunosuppressive drugs. Our results showed a higher rate of persistent vascular uptake.…”

Section: Discussionmentioning

confidence: 95%

Evidence for uncoupling of clinical and 18-FDG activity of PET/CT scan improvement in tocilizumab-treated patients with large-vessel giant cell arteritis

Peña

Martínez-Rodríguez

Atienza‐Mateo

et al. 2021

Clinical and Experimental Rheumatology

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Objective. Clinical improvement following tocilizumab (TCZ) therapy in patients with large-vessel (LVV) giant cell arteritis (GCA) is well established. However, information on TCZ effect on imaging vascular activity is limited. We aimed to determine if clinical improvement correlated with reduction of vascular 18 F-fluorodeoxyglucose ( 18 F-FDG) uptake in positron emission tomography (PET/CT) scans. Methods. Observational study of patients with refractory LVV-GCA treated with TCZ who had a baseline and a follow-up 18 F-FDG-PET/CT scan. For the visual analysis of 18 F-FDG vascular uptake, a total vascular score (TVS) was defined, ranging from 0 to 15. Besides, a semiquantitative analysis was performed as a target to background ratio (TBR)= SUVmax thoracic aorta wall/SUVmax aortic vascular pool. The baseline and follow-up TVS and TBR were compared. Clinical and laboratory outcomes were also assessed. Results. We included 30 patients (24 women/6 men); mean age±standard deviation 65.7±9.8 years. Baseline PET/CT scans were performed due to active disease at a median [interquartile range-IQR] of 1.5 [0.0-4.0] months before TCZ onset. Following TCZ therapy, 25 (83.33%) patients achieved clinical remission and reduction of 18 F-FDG vascular uptake was also observed after a mean ± standard deviation of 10.8±3.7 months. TBR decreased from 1.70 ± 0.52 to 1.48 ± 0.25 (p=0.005) and TVS from 4.97±2.62 to 3.13±1.89 (p< 0.001). However, only 9 (30.0%) patients showed complete normalisation of TBR and only 3 (10%) normalisation of TVS. TBR and TVS showed a good correlation (r=0.576). Conclusion.Although most LVV-GCA patients achieve clinical remission after TCZ therapy, less than one-third show normalisation of 18 F-FDG vascular uptake.

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“…Discordant results were resolved by a consensus. Scores were summed to give a total, large, and cranial vascular scores (17).…”

Section: Methodsmentioning

confidence: 99%

The Clinical Significance of Small Vessel Vasculitis on Temporal Artery Biopsies

Quigley

Sammel²,

Laurent³

et al. 2022

Journal of Neuro-Ophthalmology

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Background:Giant cell arteritis (GCA) is the most common type of systemic vasculitis in the elderly. Untreated, it can lead to irreversible blindness. Its diagnosis relies on a temporal artery biopsy (TAB). However, a proportion of patients have small vessel vasculitis (SVV) on biopsy; the prognosis of which remains unclear. The aim of this study is to compare the clinical presentation and long-term outcomes of those with SVV with negative and positive biopsies to determine whether long-term corticosteroid therapy can be avoided in these patients.Methods:Post hoc analysis of patients with suspected GCA who underwent TAB and fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan as part of a prospective GCA and PET cohort. Patients were divided in to 3 groups based on TAB result: positive (inflammation in the main artery wall), negative (no inflammation), and SVV (isolated vasa vasorum or periadventitial SVV). Clinical, serological, and PET/CT data of patients with SVV were compared with those with positive and those with negative biopsies.Results:For the 58 eligible patients recruited between May 2016 and December 2017, 11 had SVV, 12 had positive, and 35 had negative biopsies. Patients with SVV had similar clinical, serological, and PET/CT findings to those with negative biopsies. Compared with those with positive biopsies, patients with SVV had lower erythrocyte sedimentation rate (25 vs 78 mm/hour; P = 0.02), platelet count (296 vs 385 ×109/L; P = 0.03), and a lower median total vascular score on PET/CT scan (1.0 vs 13.5; P = 0.01). Median prednisone dose was lower (4.8 vs 11.7 mg; P = 0.015) and fewer were on steroid-sparing agents (20% vs 67%; P = 0.043) at 6 months. The percentage of patients with a clinical diagnosis of GCA was similar between those with SVV (3/11, 27.3%) and those with negative biopsies (5/35, 14.3%; P = 0.374).Conclusions:Patients with SVV on TAB had similar clinical features, PET/CT findings, and 6-month outcomes to those with negative biopsies. Small vessel vasculitis can be treated as equivalent to a negative biopsy when being considered for diagnosis and treatment of GCA.

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Cranial and large vessel activity on positron emission tomography scan at diagnosis and 6 months in giant cell arteritis

Cited by 27 publications

References 20 publications

Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis

Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis

Evidence for uncoupling of clinical and 18-FDG activity of PET/CT scan improvement in tocilizumab-treated patients with large-vessel giant cell arteritis

The Clinical Significance of Small Vessel Vasculitis on Temporal Artery Biopsies

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