Positron Emission Tomography/Computerized Tomography in Newly Diagnosed Patients with Giant Cell Arteritis Who Are Taking Glucocorticoids
Positron Emission Tomography/Computerized Tomography in Newly Diagnosed Patients with Giant Cell Arteritis Who Are Taking Glucocorticoids
复制标题
DOI：
10.3899/jrheum.170138
复制
发表时间：
2017-12-01
影响因子：
3.9
通讯作者：
Hanly, John G.
中科院分区：
文献类型：
--
作者：
Clifford, Alison H.;Murphy, Elana M.;Hanly, John G.
Objective.正电子发射断层扫描/计算机断层扫描（PET/CT）上的大血管摄取支持巨细胞动脉炎（GCA）的诊断。然而，它的价值，在颞动脉活检没有动脉炎的患者和那些接受糖皮质激素仍然未知。我们比较了颞动脉活检阳性（TAB+）和阴性（TAB-）的GCA患者和对照组的PET/CT结果。开始接受糖皮质激素治疗的新临床诊断GCA患者接受了颞动脉活检和PET/CT。采用视觉半定量方法，对8个血管区域的18F-氟脱氧葡萄糖（FDG）摄取进行评分，并对患者和对照组进行总体评分。入组了28例GCA患者和28例对照。18例GCA患者为TAB+。与对照组相比，GCA患者在平均11.9天泼尼松治疗后的平均PET/CT评分较高，总摄取（10.34 +/- 2.72 vs 7.73 +/- 2.56; p = 0.001）和8个特定血管区域中的6个。TAB+和TAB-GCA患者的PET/CT评分相似。区分GCA病例和对照组的最佳临界值是PET/CT总分≥ 9，受试者工作特征曲线下面积为0.75，敏感性为71.4%，特异性为64.3%。在GCA患者中，这些指标与更高的PET/CT总评分相关：全身症状（p = 0.015），较低的血红蛋白（p = 0.009）和较高的血小板计数（p = 0.008）。大多数GCA患者尽管暴露于泼尼松，但血管FDG摄取评分增加;然而，PET/CT在这种情况下的敏感性和特异性低于先前报道的那些。
Objective. Large vessel uptake on positron emission tomography/computerized tomography (PET/CT) supports the diagnosis of giant cell arteritis (GCA). Its value, however, in patients without arteritis on temporal artery biopsy and in those receiving glucocorticoids remains unknown. We compared PET/CT results in GCA patients with positive (TAB+) and negative temporal artery biopsies (TAB-), and controls.Methods. Patients with new clinically diagnosed GCA starting treatment with glucocorticoids underwent temporal artery biopsy and PET/CT. Using a visual semiquantitative approach, 18F-fluorodeoxyglucose (FDG) uptake was scored in 8 vascular territories and summed overall to give a total score in patients and matched controls.Results. Twenty-eight patients with GCA and 28 controls were enrolled. Eighteen patients with GCA were TAB+. Mean PET/CT scores after an average of 11.9 days of prednisone were higher in patients with GCA compared to controls, for both total uptake (10.34 +/- 2.72 vs 7.73 +/- 2.56; p = 0.001), and in 6 of 8 specific vascular territories. PET/CT scores were similar between TAB+ and TAB-patients with GCA. The optimal cutoff for distinguishing GCA cases from controls was a total PET/CT score of >= 9, with an area under the receiver-operating characteristic curve of 0.75, sensitivity 71.4%, and specificity 64.3%. Among patients with GCA, these measures correlated with greater total PET/CT scores: systemic symptoms (p = 0.015), lower hemoglobin (p = 0.009), and higher platelet count (p = 0.008).Conclusion. Vascular FDG uptake scores were increased in most patients with GCA despite exposure to prednisone; however, the sensitivity and specificity of PET/CT in this setting were lower than those previously reported.