Management of large-vessel vasculitis with FDG-PET: a systematic literature review and meta-analysis

Michael Soussan, Patrick Nicolas, Catherine Schramm, Sandrine Katsahian, Gabriel Pop, Olivier Fain, Arsene Mekinian, Michael Soussan, Patrick Nicolas, Catherine Schramm, Sandrine Katsahian, Gabriel Pop, Olivier Fain, Arsene Mekinian

Abstract

We aimed to clarify the role of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in the management of large-vessel vasculitis (LVV), focusing on 3 issues which are as follows: describe and determine the different FDG-PET criteria for the diagnosis of vascular inflammation, the performance of FDG-PET for the diagnosis of large-vessel inflammation in giant cell arteritis (GCA) patients, and the performance of FDG-PET to evaluate the disease inflammatory activity in Takayasu arteritis (TA) patients. MEDLINE, Cochrane Library, and EMBASE database were searched for articles that evaluated the value of FDG-PET in LVV, from January 2000 to December 2013. Inclusion criteria were American College of Rheumatology criteria for GCA or TA, definition PET positivity threshold, and >4 cases included. Sensitivity (Se) and specificity (Sp) of FDG-PET for the diagnosis of large-vessel inflammation were calculated from each included individual study, and then pooled for meta-analysis with a random-effects model. Twenty-one studies (413 patients, 299 controls) were included in the systematic review. FDG-PET showed FDG vascular uptake in 70% (288/413) of patients and 7% (22/299) of controls. Only vascular uptake equal to or higher than the liver uptake was significantly different between GCA/TA patients and controls (P < 0.001). The meta-analysis of GCA patients (4 studies, 57 patients) shows that FDG-PET has high Se and Sp for the diagnosis of large-vessel inflammation in GCA patients in comparison to controls, with a pooled Se at 90% (95% confidence interval [CI], 79%-93%) and a pooled Sp at 98% (95% CI, 94%-99%). The meta-analysis of TA patients (7 studies, 191 patients) shows that FDG-PET has a pooled Se at 87% (95% CI, 78%-93%) and Sp at 73% (95% CI, 63%-81%) for the assessment of disease activity in TA, with up to 84% Sp, with studies using National Institutes of Health criteria as the disease activity assessment scale. FDG-PET showed good performances in the diagnosis of large-vessel inflammation, with higher accuracy in GCA patients than in TA patients. Although a vascular uptake equal to or higher than the liver uptake appears to be a good criterion for the diagnosis of vascular inflammation, further studies are needed to define the threshold of significance as well as the clinical significance of the vascular uptake.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Diagnosis of LVV in patients with GCA by using FDG-PET: forest plots of eligible studies show individual and pooled sensitivities and specificities of the studies included in the meta-analysis and the related inconsistency index. FDG-PET = 18F-fluorodeoxyglucose positron emission tomography, GCA = giant cell arteritis, LVV = large-vessel vasculitis.
FIGURE 2
FIGURE 2
FDG-PET for the disease activity in TA: forest plots of eligible studies show individual and pooled sensitivities and specificities of the studies included in the meta-analysis: (A): all studies with TA (B): studies with disease activity evaluated only with NIH scale. Inconsistency index squared was also determined. FDG-PET = 18F-fluorodeoxyglucose positron emission tomography, NIH = National Institutes of Health, TA = Takayasu arteritis.

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