title: The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis.
abstract: OBJECTIVE
  We aimed to assess the impact of (18)F-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 (18)F-FDG PET, respectively. The accuracy of the clinical diagnosis and the resulting clinical management with and without the (18)F-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. (18)F-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 (18)F-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 (18)F-FDG PET increased the clinical diagnostic accuracy from 54.1 to 70.5% (p = 0.04). The addition of (18)F-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.
  
  
  CONCLUSIONS
  (18)F-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.
authors.affiliation: Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031 Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Fuchs
authors.forename: Matthias
authors.initials: M
authors.lastname: Briel
authors.forename: Thomas
authors.initials: T
authors.lastname: Daikeler
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Walker
authors.forename: Helmut
authors.initials: H
authors.lastname: Rasch
authors.forename: Scott
authors.initials: S
authors.lastname: Berg
authors.forename: Quinn K T
authors.initials: QK
authors.lastname: Ng
authors.forename: Heike
authors.initials: H
authors.lastname: Raatz
authors.forename: David
authors.initials: D
authors.lastname: Jayne
authors.forename: Ina
authors.initials: I
authors.lastname: Kötter
authors.forename: Daniel
authors.initials: D
authors.lastname: Blockmans
authors.forename: Maria C
authors.initials: MC
authors.lastname: Cid
authors.forename: Sergio
authors.initials: S
authors.lastname: Prieto-González
authors.forename: Peter
authors.initials: P
authors.lastname: Lamprecht
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
authors.forename: Zaharenia
authors.initials: Z
authors.lastname: Karageorgaki
authors.forename: Richard
authors.initials: R
authors.lastname: Watts
authors.forename: Raashid
authors.initials: R
authors.lastname: Luqmani
authors.forename: Jan
authors.initials: J
authors.lastname: Müller-Brand
authors.forename: Alan
authors.initials: A
authors.lastname: Tyndall
authors.forename: Martin A
authors.initials: MA
authors.lastname: Walter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001167:Arteritis / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000494:pharmacology*; D012044:Regression Analysis; D015203:Reproducibility of Results; D012219:Rheumatology / Q000379:methods; D012680:Sensitivity and Specificity; D013625:Takayasu Arteritis / Q000473:pathology; D014657:Vasculitis / Q000000981:diagnostic imaging* / Q000188:drug therapy*
chemical_list: D007166:Immunosuppressive Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
references.citation: Ann Rheum Dis. 2010 Oct;69(10):1744-50
references.pmid: 20448283
references.citation: Clin Nucl Med. 2008 Dec;33(12):872-3
references.pmid: 19033793
references.citation: J Nucl Med. 2002 May;43(5):652-7
references.pmid: 11994530
references.citation: J Nucl Med. 2002 May;43(5):658-63
references.pmid: 11994531
references.citation: Am J Med. 2004 Jan 1;116(1):50-3
references.pmid: 14706666
references.citation: Arthritis Rheum. 2006 Feb 15;55(1):131-7
references.pmid: 16463425
references.citation: Vasc Med. 2003 May;8(2):127-8
references.pmid: 14518615
references.citation: Ann Intern Med. 2002 Aug 20;137(4):232-8
references.pmid: 12186513
references.citation: Fam Pract Res J. 1993 Mar;13(1):15-24
references.pmid: 8484338
references.citation: Arthritis Rheum. 2004 Feb 15;51(1):128-39
references.pmid: 14872466
references.citation: Rheumatology (Oxford). 2008 Aug;47(8):1179-84
references.pmid: 18515868
references.citation: Ann Rheum Dis. 2009 Mar;68(3):318-23
references.pmid: 18413441
references.citation: Eur J Nucl Med Mol Imaging. 2004 May;31(5):627-34
references.pmid: 14730404
references.citation: Nat Clin Pract Oncol. 2008 Mar;5(3):160-70
references.pmid: 18253106
references.citation: Ann Rheum Dis. 2010 Jul;69(7):1356-9
references.pmid: 20498213
references.citation: Ann Rheum Dis. 2004 Nov;63(11):1507-10
references.pmid: 15479905
references.citation: Arthritis Rheum. 2002 Jun;46(6):1634-42
references.pmid: 12115196
references.citation: Radiol Clin North Am. 2007 Jul;45(4):735-44, viii
references.pmid: 17706537
references.citation: Clin Exp Rheumatol. 2008 May-Jun;26(3 Suppl 49):S47-52
references.pmid: 18799053
references.citation: Curr Opin Rheumatol. 2004 Jan;16(1):31-7
references.pmid: 14673386
references.citation: Arch Intern Med. 2001 Apr 9;161(7):1003-7
references.pmid: 11295964
references.citation: Rheumatology (Oxford). 1999 May;38(5):444-7
references.pmid: 10371283
references.citation: J Comput Assist Tomogr. 1999 Jan-Feb;23(1):16-8
references.pmid: 10050800
references.citation: Eur J Nucl Med Mol Imaging. 2003 May;30(5):730-6
references.pmid: 12677302
references.citation: Curr Opin Rheumatol. 2009 Jan;21(1):19-28
references.pmid: 19077714
references.citation: Rheumatology (Oxford). 2004 Feb;43(2):241-2
references.pmid: 13130153
references.citation: Eur J Nucl Med Mol Imaging. 2005 Jun;32(6):674-81
references.pmid: 15747154
references.citation: Lancet. 2008 Jul 19;372(9634):234-45
references.pmid: 18640460
references.citation: Cleve Clin J Med. 2002;69 Suppl 2:SII95-9
references.pmid: 12086275
references.citation: AJR Am J Roentgenol. 2010 Mar;194(3):848-56
references.pmid: 20173169
references.citation: Eur Radiol. 2003 Feb;13(2):400-5
references.pmid: 12599007