18F-Fluorodeoxyglucose-Positron Emission Tomography As an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients With Large Vessel Vasculitis
18F-Fluorodeoxyglucose-Positron Emission Tomography As an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients With Large Vessel Vasculitis
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DOI：
10.1002/art.40379
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发表时间：
2018-03-01
影响因子：
13.3
通讯作者：
Ahlman, Mark A.
中科院分区：
文献类型：
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作者：
Grayson, Peter C.;Alehashemi, Sara;Ahlman, Mark A.
客观的。旨在评估 F-18-氟脱氧葡萄糖 (FDG) 正电子发射断层扫描 (PET) 在大血管血管炎 (LVV) 患者和对照受试者的前瞻性队列中的临床价值。方法。研究人员对患有大动脉炎和巨细胞动脉炎的患者以及由高脂血症患者、患有类似 LVV 疾病的患者和健康对照组成的对照组进行了研究。参与者接受了临床评估和 FDG-PET 成像，LVV 患者每 6 个月接受一次连续成像。我们计算了 FDG-PET 解读的敏感性和特异性，用于区分临床活跃 LVV 患者、对照受试者和临床缓解疾病患者。基于整体动脉 FDG 摄取的定性总结评分，即 PET 血管活动评分 (PETVAS)，用于研究 PET 扫描活动与临床特征之间的关联，并预测复发。结果。 115 名参与者（56 名 LVV 患者和 59 名对照受试者）总共进行了 170 次 FDG-PET 扫描。 FDG-PET 将临床活动性 LVV 患者与对照受试者区分开来，敏感性为 85%（95% 置信区间 [95% CI] 69, 94），特异性为 83%（95% CI 71, 91）。大多数临床缓解的 LVV 患者（71 例中有 41 例 [58%]）FDG-PET 扫描被解释为活动性血管炎。临床疾病活动状态、疾病持续时间、体重指数和糖皮质激素的使用与 PET 扫描活动独立相关。在临床缓解期间接受 PET 的患者中，在 15 个月的中位随访期内，高 PETVAS 患者比低 PETVAS 患者未来临床复发更常见（55% vs 11%；P = 0.03）。结论。 FDG-PET 提供有关血管炎症的信息，与 LVV 临床评估相补充但又不同。临床缓解期间的 FDG-PET 扫描活动与未来的临床复发相关。
Objective. To assess the clinical value of F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in a prospective cohort of patients with large vessel vasculitis (LVV) and comparator subjects.Methods. Patients with Takayasu arteritis and giant cell arteritis were studied, along with a comparator group consisting of patients with hyperlipidemia, patients with diseases that mimic LVV, and healthy controls. Participants underwent clinical evaluation and FDG-PET imaging, and patients with LVV underwent serial imagingat 6-month intervals. We calculated sensitivity and specificity of FDG-PET interpretation for distinguishing patients with clinically active LVV from comparator subjects and from patients with disease in clinical remission. A qualitative summary score based on global arterial FDG uptake, the PET Vascular Activity Score (PETVAS), was used to study associations between activity on PET scan and clinical characteristics and to predict relapse.Results. A total of 170 FDG-PET scans were performed in 115 participants (56 patients with LVV and 59 comparator subjects). FDG-PET distinguished patients with clinically active LVV from comparator subjects with a sensitivity of 85% (95% confidence interval [95% CI] 69, 94) and a specificity of 83% (95% CI 71, 91). FDG-PET scans were interpreted as active vasculitis in most patients with LVV in clinical remission (41 of 71 [58%]). Clinical disease activity status, disease duration, body mass index, and glucocorticoid use were independently associated with activity on PET scan. Among patients who underwent PET during clinical remission, future clinical relapse was more common in patients with a high PETVAS than in those with a low PETVAS (55% versus 11%; P= 0.03) over a median follow-up period of 15 months.Conclusion. FDG-PET provides information about vascular inflammation that is complementary to, and distinct from, clinical assessment in LVV. FDG-PET scan activity during clinical remission was associated with future clinical relapse.