title: Management of large-vessel vasculitis with FDG-PET: a systematic literature review and meta-analysis.
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.
authors: From the Paris 13 University, Sorbonne Paris Cité (MS); AP-HP, Avicenne Hospital, Department of Nuclear Medicine (MS, GP); AP-HP, Avicenne Hospital, Department of Pharmacology (PN); Inserm U1138, Centre de Recherche des Cordeliers, Equipe 22, Paris 5, Paris 6 (CS, SK); APHP, HEGP, Department of Biostatistics (SK); and DHU I2P, AP-HP, Saint-Antoine Hospital, Department of Internal Medicine, Paris, France (OF, AM).
authors: Michael
authors: M
authors: Soussan
authors: Patrick
authors: P
authors: Nicolas
authors: Catherine
authors: C
authors: Schramm
authors: Sandrine
authors: S
authors: Katsahian
authors: Gabriel
authors: G
authors: Pop
authors: Olivier
authors: O
authors: Fain
authors: Arsene
authors: A
authors: Mekinian
mesh_terms: D019788:Fluorodeoxyglucose F18; D013700:Giant Cell Arteritis / Q000000981:diagnostic imaging*; D006801:Humans; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D013625:Takayasu Arteritis / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18