Vessel inflammation and morphological changes in patients with large vessel vasculitis: a retrospective study

ObjectiveThe aim was to identify any association between imaging signs of vessel wall inflammation (positron emission tomography–CT (PET-CT) score and CT/MR wall thickening) and synchronous and subsequent vascular damage (stenoses/dilations) in patients with large vessel vasculitis (LVV).MethodsConsecutive patients with LVV referred to a tertiary centre in 2007–2020 with baseline PET-CT and morphological imaging (CT/MR angiography) performed within 3 months were included. All available PET-CT and CT/MR scans were reviewed to assess PET-CT uptake (4-point semi-quantitative score), wall thickening, stenoses and dilations for 15 vascular segments. The associations of baseline PET score and CT/MR wall thickening with synchronous and incident stenoses/dilations at CT/MR performed 6–30 months from baseline were evaluated in per-segment and per-patient analyses. Respective areas under the receiver operating characteristic curve (AUC) were calculated.ResultsWe included 100 patients with LVV (median age: 48 years, 22% males). Baseline PET score and wall thickening were strongly associated (Cuzick non-parametric test for trend across order groups (NPtrend) <0.001). The association with synchronous stenoses/dilations was weak for PET score (NPtrend=0.01) and strong for wall thickening (p<0.001). In per-patient analyses, sensitivity/specificity for ≥1 synchronous stenoses/dilations were 44%/67% for PET score ≥2 and 66.7%/60.5% for wall thickening. Subsequent CTs/MRs were available in 28 patients, with seven incident stenoses/dilations. Baseline PET score was strongly associated with incident stenoses/dilations (p=0.001), while baseline wall thickening was not (p=0.708), with AUCs for incident stenoses/dilations of 0.80 for PET score and 0.52 for wall thickening.ConclusionPET score and wall thickening are strongly associated, but only baseline PET score is a good predictor of incident vessel wall damage in LVV.

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The Role of18F-FDG PET/CT in Large-Vessel Vasculitis: Appropriateness of Current Classification Criteria?

BioMed Research International ◽

10.1155/2014/687608 ◽

2014 ◽

Vol 2014 ◽

pp. 1-13 ◽

Cited By ~ 27

Author(s):

H. Balink ◽

R. J. Bennink ◽

B. L. F. van Eck-Smit ◽

H. J. Verberne

Keyword(s):

Fdg Pet ◽

Fatal Outcome ◽

Clinical Suspicion ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Arterial Stenosis ◽

Wall Thickening ◽

Temporal Artery Biopsy ◽

Pet Ct ◽

Fdg Pet Ct

Patients with clinical suspicion of large-vessel vasculitis (LVV) may present with nonspecific signs and symptoms and increased inflammatory parameters and may remain without diagnosis after routine diagnostic procedures. Both the nonspecificity of the radiopharmaceutical18F-FDG and the synergy of integrating functional and anatomical images with PET/CT offer substantial benefit in the diagnostic work-up of patients with clinical suspicion for LVV. A negative temporal artery biopsy, an ultrasonography without an arterial halo, or a MRI without aortic wall thickening or oedema do not exclude the presence of LVV and should therefore not exclude the use of18F-FDG PET/CT when LVV is clinically suspected. This overview further discusses the notion that there is substantial underdiagnosis of LVV. Late diagnosis of LVV may lead to surgery or angioplasty in occlusive forms and is often accompanied by serious aortic complications and a fatal outcome. In contrast to the American College of Rheumatology 1990 criteria for vasculitis, based on late LVV effects like arterial stenosis and/or occlusion,18F-FDG PET/CT sheds new light on the classification of giant cell arteritis (GCA) and Takayasu arteritis (TA). The combination of these observations makes the role of18F-FDG PET/CT in the assessment of patients suspected for having LVV promising.

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OP0069 THE ROLE OF POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT) IN DISEASE ACTIVITY ASSESSMENT IN PATIENTS WITH LARGE VESSEL VASCULITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3713 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 37.2-37

Author(s):

E. Galli ◽

F. Muratore ◽

L. Boiardi ◽

M. I. Casali ◽

A. Versari ◽

...

Keyword(s):

Disease Activity ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Emission Tomography ◽

Clinical Judgement ◽

Positron Emission ◽

Pet Ct ◽

Active Disease ◽

Age And Sex

Background:Assessment of disease activity in large vessel vasculitis (LVV) is still an unmet need. PET Vascular Activity Score (PETVAS) is a new composite score aimed at quantifying the overall inflammatory burden by adding together PET qualitative visual scores (0-3, according to Meller) in nine selected arterial regions (1). In two independent cohorts, PETVAS showed to be effective in discriminating between patients with clinically active and inactive vasculitis.Objectives:To assess the role of PET/CT and the performance of PETVAS in differentiating between clinically active and inactive vasculitis in a single center cohort of patients with LVV.Methods:One-hundred patients with radiographic evidence of LVV were enrolled by the Rheumatology Unit of Reggio Emilia Hospital (Italy) between June 2007 and September 2020. All subjects underwent full clinical, laboratory and imaging evaluation (including PET/CT) at baseline, annually and when a relapse was suspected. Medical records of recruited patients were retrospectively reviewed from baseline visit until 30 September 2020, last follow-up or death.For each PET/CT test, the nuclear medicine physician’s interpretation of scans (active/inactive vasculitis) was compared with disease activity clinical judgement (active disease/remission). The latter was based on comprehensive signs/symptoms assessment, laboratory and imaging (excluding PET/CT) data and was considered the reference standard.For each PET/CT scan, PETVAS score was calculated and its performance in discriminating between patients with active and inactive disease was compared to clinical judgement.Results:In the study period 100 LVV patients [51 giant cell arteritis (GCA), 49 Takayasu arteritis (TAK)] underwent a total of 474 PET scans. Nuclear medicine physician’s interpretation of PET/CT was able to discriminate between patients in clinically active LVV (n 167) and those in clinical remission (n 307) with a sensitivity of 60% (95% CI, 51 to 69%) and a specificity of 80% (95% CI, 75 to 84%). The following sensitivity and specificity values were found in LVV subgroups: 73% (95% CI, 59 to 84%) and 77% (95% CI, 70 to 83%) for TAK, and 51% (95% CI, 38 to 63%) and 82% (95% CI, 76 to 88%) for GCA, respectively.LVV patients with higher PETVAS scores were more frequently classified as having active disease: age and sex adjusted OR 1.15 (95% CI, 1.11 to 1.19), p<0.0001. Similar results were found in LVV subgroups, [age and sex adjusted OR 1.12 (95% CI, 1.08 to 1.17) for GCA and 1.22 (95% CI, 1.14 to 1.31) for TAK, all p<0.0001].The area under receiver operating characteristics (ROC) curve (AUC) of PETVAS in differentiating between clinically active and inactive LVV was 0.73 (95% CI, 0.68 to 0.79). Similar results were found in LVV subgroups, [0.70 (95% CI, 0.62 to 0.78) for GCA, and 0.79 (95% CI, 0.71 to 0.87) for TAK]. A PETVAS ≥10 provided 61% sensitivity and 80% specificity in differentiating between clinically active and inactive LVV (52% sensitivity and 82% specificity in GCA subgroup and 73% sensitivity and 78% specificity in TAK subgroup).Conclusion:In our cohort PET/CT has shown to be useful in monitoring LVV disease activity.PETVAS seems to be a reliable tool in helping clinicians to discriminate between LVV patients with active disease and those in remission.References:[1]Grayson PC, Alehashemi S, Bagheri AA, Civelek AC, Cupps TR, Kaplan MJ, Malayeri AA, Merkel PA, Novakovich E, Bluemke DA, Ahlman MA. 18 F-Fluorodeoxyglucose-Positron Emission Tomography as an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients with Large Vessel Vasculitis. Arthritis Rheumatol. 2018 Mar;70(3):439-449. doi: 10.1002/art.40379. Epub 2018 Feb 6. PMID: 29145713; PMCID: PMC5882488.Disclosure of Interests:None declared

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The utility of PET/CT in large vessel vasculitis

Scientific Reports ◽

10.1038/s41598-020-73818-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Jennifer Ben Shimol ◽

Howard Amital ◽

Merav Lidar ◽

Liran Domachevsky ◽

Yehuda Shoenfeld ◽

...

Keyword(s):

Autoimmune Diseases ◽

Fdg Pet ◽

Vessel Wall ◽

Systemic Vasculitis ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Ct Scans ◽

Pet Ct ◽

Previously Treated ◽

Fdg Pet Ct

Abstract 18F-FDG PET/CT occupies a growing role in the diagnosis of large vessel vasculitis (LVV), illustrating enhanced uptake in the lining of large vessels. A retrospective single center study was conducted of patients who underwent 18F-FDG PET/CT scans between 2009 and 2019 at Sheba Medical Center, Israel. The imaging results were analyzed for evidence of LVV. We reviewed the PET/CT scans of 126 patients and identified 57 studies that either showed evidence of active LVV or that had been performed in patients previously treated for systemic vasculitis. In 6 patients with fevers of unknown origin and elevated inflammatory markers, PET/CT revealed LVV. Six of 13 patients previously treated for systemic vasculitis demonstrated persistent large vessel uptake. LVV was identified in 8 patients with other autoimmune diseases, and in 4 diagnosed with infectious aortitis. In 26 patients who underwent malignancy surveillance, PET/CT revealed more localized large vessel wall inflammation. Our results illustrate that PET/CT may identify large vessel wall inflammation in patients with a suspicion of LVV, and incidentally in patients who undergo malignancy surveillance. PET/CT may also help delineate the presence and extent of vessel inflammation in patients with LVV and in those with other autoimmune diseases.

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Comparison Between 18F-Dopa and 18F-Fet PET/CT in Patients with Suspicious Recurrent High Grade Glioma: A Literature Review and Our Experience

Current Radiopharmaceuticals ◽

10.2174/1874471012666190115124536 ◽

2019 ◽

Vol 12 (3) ◽

pp. 220-228 ◽

Cited By ~ 1

Author(s):

Laura Evangelista ◽

Lea Cuppari ◽

Luisa Bellu ◽

Daniele Bertin ◽

Mario Caccese ◽

...

Keyword(s):

Case Series ◽

High Grade Glioma ◽

High Grade ◽

True Negative ◽

Fet Pet ◽

Positron Emission ◽

Pet Ct ◽

Magnetic Resonance Imaging Mri ◽

Definition Of ◽

Sensitivity Specificity

Purpose: The aims of the present study were to: 1- critically assess the utility of L-3,4- dihydroxy-6-18Ffluoro-phenyl-alanine (18F-DOPA) and O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) Positron Emission Tomography (PET)/Computed Tomography (CT) in patients with high grade glioma (HGG) and 2- describe the results of 18F-DOPA and 18F-FET PET/CT in a case series of patients with recurrent HGG. Methods: We searched for studies using the following databases: PubMed, Web of Science and Scopus. The search terms were: glioma OR brain neoplasm and DOPA OR DOPA PET OR DOPA PET/CT and FET OR FET PET OR FET PET/CT. From a mono-institutional database, we retrospectively analyzed the 18F-DOPA and 18F-FET PET/CT of 29 patients (age: 56 ± 12 years) with suspicious for recurrent HGG. All patients underwent 18F-DOPA or 18F-FET PET/CT for a multidisciplinary decision. The final definition of recurrence was made by magnetic resonance imaging (MRI) and/or multidisciplinary decision, mainly based on the clinical data. Results: Fifty-one articles were found, of which 49 were discarded, therefore 2 studies were finally selected. In both the studies, 18F-DOPA and 18F-FET as exchangeable in clinical practice particularly for HGG patients. From our institutional experience, in 29 patients, we found that sensitivity, specificity and accuracy of 18F-DOPA PET/CT in HGG were 100% (95% confidence interval- 95%CI - 81-100%), 63% (95%CI: 39-82%) and 62% (95%CI: 39-81%), respectively. 18F-FET PET/CT was true positive in 4 and true negative in 4 patients. Sensitivity, specificity and accuracy for 18F-FET PET/CT in HGG were 100%. Conclusion: 18F-DOPA and 18F-FET PET/CT have a similar diagnostic accuracy in patients with recurrent HGG. However, 18F-DOPA PET/CT could be affected by inflammation conditions (false positive) that can alter the final results. Large comparative trials are warranted in order to better understand the utility of 18F-DOPA or 18F-FET PET/CT in patients with HGG.

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A Review on the Value of Imaging in Differentiating between Large Vessel Vasculitis and Atherosclerosis

Journal of Personalized Medicine ◽

10.3390/jpm11030236 ◽

2021 ◽

Vol 11 (3) ◽

pp. 236

Author(s):

Pieter H. Nienhuis ◽

Gijs D. van Praagh ◽

Andor W. J. M. Glaudemans ◽

Elisabeth Brouwer ◽

Riemer H. J. A. Slart

Keyword(s):

Fdg Pet ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Current Evidence ◽

Future Directions ◽

Inflammatory Conditions ◽

Positron Emission ◽

Magnetic Resonance Imaging Mri ◽

Review Reports ◽

Ct Studies

Imaging is becoming increasingly important for the diagnosis of large vessel vasculitis (LVV). Atherosclerosis may be difficult to distinguish from LVV on imaging as both are inflammatory conditions of the arterial wall. Differentiating atherosclerosis from LVV is important to enable optimal diagnosis, risk assessment, and tailored treatment at a patient level. This paper reviews the current evidence of ultrasound (US), 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET), computed tomography (CT), and magnetic resonance imaging (MRI) to distinguish LVV from atherosclerosis. In this review, we identified a total of eight studies comparing LVV patients to atherosclerosis patients using imaging—four US studies, two FDG-PET studies, and two CT studies. The included studies mostly applied different methodologies and outcome parameters to investigate vessel wall inflammation. This review reports the currently available evidence and provides recommendations on further methodological standardization methods and future directions for research.

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P205 The contemporary presentation and management of giant cell arteritis with large vessel vasculitis

Rheumatology ◽

10.1093/rheumatology/keab247.200 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Owen Cronin ◽

Neil D McKay ◽

Hannah Preston ◽

Helen Harris ◽

Barbara Hauser

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Polymyalgia Rheumatica ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Ct Angiogram ◽

Pet Ct ◽

The Mean ◽

Vessel Involvement

Abstract Background/Aims Giant cell arteritis with large vessel vasculitis (LV-GCA) represents a distinct, less researched sub-category of giant cell arteritis (GCA). In comparison to cranial GCA, the patient’s diagnostic pathway is less well described and it is thought that LV-GCA is underdiagnosed, including in patients with polymyalgia rheumatica and cranial-GCA. Advances in imaging (e.g. PET-CT) and treatment (tocilizumab), have provided additional options in the diagnosis and management of LV-GCA. The aim was to describe the contemporary clinical journey for patients diagnosed with LV-GCA. Methods The electronic patient health record system in NHS Lothian (TrakCare) was used to collect relevant data. Patients with imaging-confirmed large vessel vasculitis, diagnosed with GCA after 1 January 2017 were included. Follow-up was until August 2020. Results Eighteen patients with LV-GCA were included. The mean age was 65 years and 66.7% were female. Two patients had known cranial-GCA but 89% of patients were diagnosed exclusively with large vessel involvement. The most common symptoms were malaise (55%), weight loss (55%), polymyalgia rheumatica (55%) and limb claudication (44%). Pyrexia of unknown origin was a feature in only 17% of patients. Two patients were asymptomatic and were investigated on the basis of raised inflammatory markers. Mean CRP at baseline was 99mg/L and ESR 85mm/hour. The mean time from symptom-onset to diagnosis was 6.8 months (range 1 to 15 months). Sixteen patients (89%) were reviewed by at least one other secondary care specialist. One third of patients were referred from General Medicine followed by Vascular Surgery (16%) and General Practice (16%). 7/18 patients were inpatients at the time of referral. 56% of patients required two modalities of imaging to confirm large vessel involvement. The most commonly used imaging techniques (in descending order) were CT-Chest/Abdomen/Pelvis, CT-angiogram, PET-CT and Vascular Ultrasound. 50% of patients underwent follow-up imaging, most commonly MR- or CT-angiography. Mean follow-up was for 1.6 years. The mean prednisolone dose at 3 months (n = 18) was 24mg daily and 8mg at 12 months (n = 12). 28% of patients relapsed during the follow-up period at 4, 5, 8, 9 and 24 months post-diagnosis. 7/18 patients were commenced on methotrexate for steroid-side effects or for relapse. 8/18 received subcutaneous tocilizumab in combination with methotrexate in two cases. Three patients were started on azathioprine but only one continued. Conclusion In modern-day clinical practice, patients with LV-GCA experience a longer time to diagnosis than those with cranial symptoms. Patients with LV-GCA can experience an array of constitutional symptoms. Frequently, more than one imaging modality is required to confirm LV-GCA and the majority of patients will have seen other hospital specialists or have been admitted to hospital before diagnosis. Methotrexate and tocilizumab are the most frequently-used and effective steroid-adjunct in this single-centre cohort. Disclosure O. Cronin: None. N.D. McKay: Consultancies; Gilead. Other; Has received support for conference attendance from Pfizer and Gilead, Has received educational support from UCB, Gilead, Celgene, Biogen, Sanofi, Abbvie, Novartis, Pfizer. H. Preston: None. H. Harris: None. B. Hauser: None.

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Diagnostic accuracy of 18F-FDG PET or PET/CT for large vessel vasculitis

Zeitschrift für Rheumatologie ◽

10.1007/s00393-015-1674-2 ◽

2015 ◽

Vol 75 (9) ◽

pp. 924-931 ◽

Cited By ~ 31

Author(s):

Y.H. Lee ◽

S.J. Choi ◽

J.D. Ji ◽

G.G. Song

Keyword(s):

Diagnostic Accuracy ◽

Fdg Pet ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Pet Ct ◽

18F Fdg

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FRI0262 The Role of 18F-FDG-PET/CT in the Diagnosis and Follow-Up of Large Vessel Vasculitis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-eular.4237 ◽

2015 ◽

Vol 74 (Suppl 2) ◽

pp. 519.2-519

Author(s):

G. Pazzola ◽

M. Casali ◽

F. Muratore ◽

N. Pipitone ◽

L. Boiardi ◽

...

Keyword(s):

Fdg Pet ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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The role of 18F-FDG PET/CT in the management of large-vessel vasculitis: applications and limitations in clinical practice

Italian Journal of Medicine ◽

10.4081/itjm.2011.249 ◽

2012 ◽

pp. 249-254

Author(s):

Maria V. Mattoli ◽

Giorgio Treglia ◽

Lucia Leccisotti ◽

Alessandro Giordano

Keyword(s):

Clinical Practice ◽

Fdg Pet ◽

False Negative ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Metabolic Imaging ◽

Small Vessel Vasculitis ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Introduction: 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) plays a key role in oncology, and it is now being used increasingly to diagnose, characterize, and monitor disease activity in inflammatory disorders, including vasculitis. Unfortunately, its role in the management of vasculitis is still not well-defined, and clinicians are often unsure how this metabolic imaging technique should be used in these diseases, although its usefulness in diagnosing large-vessel vasculitis has been clearly demonstrated. Materials and methods: We reviewed the literature about the use of PET/CT in the management of vasculitis in an attempt to identify the applications and the limitations of this technique in clinical practice. Results and discussion: Our literature review revealed that 18F-FDG PET/CT is a useful tool for diagnosing vasculitis (especially when the symptoms of the disease are non-specific); guiding biopsy procedures (areas with high glucose consumption); evaluating disease extension; and monitoring treatment responses. The main limitations of this method are the relatively low spatial resolution of the tomograph, which can lead to false-negative results in the presence of small-vessel vasculitis, and risk of false positive results, especially those related to the presence of atherosclerosis and to post-treatment vascular remodeling.

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