title: Positron emission tomography and computed tomography angiography for the diagnosis of giant cell arteritis: A real-life prospective study.
abstract: The use of 18F-fluoro-deoxyglucose positron emission tomography scan (FDG-PET) and computed tomography angiography (CTA) to improve accuracy of diagnosis of giant cell arteritis (GCA) is a very important clinical need. We aimed to compare the diagnostic performance of FDG-PET and CTA in patients with GCA.FDG-PET and CTA were acquired in all consecutive patients suspected for GCA. Results of FDG-PET and CTA were compared with the final diagnosis based on clinical judgment, temporal artery biopsy (TAB) findings, and ACR criteria. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for each method.Twenty-four patients suspected for GCA were included. Fifteen (62.5%) were ultimately diagnosed as having GCA. Among them, all fulfilled ACR criteria and 6 had biopsy-proven GCA. Strong FDG uptake in large vessels was found in 10 patients who all had GCA. Mean maximal standard uptake values (SUVmax) per patient measured at all the arterial territories were of 3.7 (range: 2.8-4.7). FDG uptake was negative in 14 patients including 9 and 5 patients without and with GCA, respectively. Mural thickening suggestive of aortitis or branch vessel arteritis was observed on CTA in 11 patients with and 2 patients without GCA. No mural thickening was observed in 11 patients including 7 patients without and 4 patients with GCA. Overall, sensitivity was 66.7% and 73.3%, specificity was 100% and 84.6%, NPV was 64.3% and 64.6%, and PPV was 100% and 84.6% of FDG-PET and CTA, respectively.Both FDG-PET and CTA have a strong diagnostic yield for the diagnosis of GCA. FDG-PET appeared to have a higher PPV as compared to CTA and may be the preferred noninvasive technique to explore patients with suspected GCA.
authors.affiliation: Département de Médecine Interne Département de Médecine Nucléaire Département de Rhumatologie Département de Radiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité Département de Médecine Interne, Hôpital Saint Antoine, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris INSERM U1149 Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Lariviere
authors.forename: Khadija
authors.initials: K
authors.lastname: Benali
authors.forename: Baptiste
authors.initials: B
authors.lastname: Coustet
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Pasi
authors.forename: Fabien
authors.initials: F
authors.lastname: Hyafil
authors.forename: Isabelle
authors.initials: I
authors.lastname: Klein
authors.forename: Maria
authors.initials: M
authors.lastname: Chauchard
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Alexandra
authors.forename: Tiphaine
authors.initials: T
authors.lastname: Goulenok
authors.forename: Antoine
authors.initials: A
authors.lastname: Dossier
authors.forename: Philippe
authors.initials: P
authors.lastname: Dieude
authors.forename: Thomas
authors.initials: T
authors.lastname: Papo
authors.forename: Karim
authors.initials: K
authors.lastname: Sacre
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D000072226:Computed Tomography Angiography; D005260:Female; D019788:Fluorodeoxyglucose F18; D013700:Giant Cell Arteritis / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002097:C-Reactive Protein