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 TyndallMartin A. Walter

Research output: Contribution to journalArticle

145 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)344-353
Number of pages10
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume39
Issue number2
Early online date10 Nov 2011
DOIs
Publication statusPublished - Feb 2012

Cite this