Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 151 No. 2324 (2021)

18F-FDG PET/CT compared with ultrasound and biopsy for detection of vasculitis of the temporal artery branches

DOI
https://doi.org/10.4414/smw.2021.20512
Cite this as:
Swiss Med Wkly. 2021;151:w20512
Published
23.06.2021

Summary

AIMS

To describe the feasibility and diagnostic accuracy of 18F-FDG positron emission tomography-computed tomography (PET/CT) of the temporal artery compared with temporal artery ultrasound and histology of the temporal artery in patients with suspicion of having giant cell arteritis (GCA).

MATERIALS AND METHODS

Patients with suspected GCA were included. PET/CT standard uptake value ratios and the compression sign on ultrasound were assessed for the trunk, and parietal and frontal branches of the temporal artery. Temporal artery biopsies were systematically re-assessed, if available.

RESULTS

In 17/34 patients, GCA was confirmed. Temporal artery PET/CT confirmed vasculitis in 9/17 patients and was negative in all 17 controls. Nineteen of 34 subjects had a temporal artery biopsy, which was positive in 7 patients. Five of these seven were negative in the preceding PET/CT. Ultrasound confirmed vasculitis in 9/17 patients and was negative in 16/17 controls. In 7/17 patients, PET/CT and ultrasound were positive for temporal arteritis. Two patients had positive findings only on temporal artery PET/CT and two patients showed vasculitis only on temporal artery ultrasound. No temporal artery segments <1.4 mm were positive on PET/CT. The parietal branches were PET/CT-positive in two patients only. In contrast, on ultrasound vasculitic findings were equally distributed amongst all branches. Sensitivity and specificity for identification of temporal artery involvement was 53% and 100% for PET/CT, and 53% and 94% for ultrasound, respectively.

CONCLUSIONS

Assessment of the temporal artery with PET/CT is a valuable extension in the diagnostic workup for GCA. PET/CT and ultrasound have comparable diagnostic accuracy, but differ on a segment and a patient level and may thus be used as complementary tests. PET/CT has a lower sensitivity for the parietal branch than ultrasound and histology.

References

  1. Fuchs M, Briel M, Daikeler T, Walker UA, Rasch H, Berg S, et al. The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging. 2012;39(2):344–53. doi:.https://doi.org/10.1007/s00259-011-1967-x
  2. Imfeld S, Rottenburger C, Schegk E, Aschwanden M, Juengling F, Staub D, et al. [18F]FDG positron emission tomography in patients presenting with suspicion of giant cell arteritis-lessons from a vasculitis clinic. Eur Heart J Cardiovasc Imaging. 2018;19(8):933–40. doi:.https://doi.org/10.1093/ehjci/jex259
  3. Dejaco C, Ramiro S, Duftner C, Besson FL, Bley TA, Blockmans D, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis. 2018;77(5):636–43. doi:.https://doi.org/10.1136/annrheumdis-2017-212649
  4. Slomka PJ, Pan T, Germano G. Recent Advances and Future Progress in PET Instrumentation. Semin Nucl Med. 2016;46(1):5–19. doi:.https://doi.org/10.1053/j.semnuclmed.2015.09.006
  5. Nielsen BD, Hansen IT, Kramer S, Haraldsen A, Hjorthaug K, Bogsrud TV, et al. Simple dichotomous assessment of cranial artery inflammation by conventional 18F-FDG PET/CT shows high accuracy for the diagnosis of giant cell arteritis: a case-control study. Eur J Nucl Med Mol Imaging. 2019;46(1):184–93. doi:.https://doi.org/10.1007/s00259-018-4106-0
  6. Sammel AM, Hsiao E, Schembri G, Nguyen K, Brewer J, Schrieber L, et al. Diagnostic Accuracy of Positron Emission Tomography/Computed Tomography of the Head, Neck, and Chest for Giant Cell Arteritis: A Prospective, Double-Blind, Cross-Sectional Study. Arthritis Rheumatol. 2019;71(8):1319–28. doi:.https://doi.org/10.1002/art.40864
  7. Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990;33(8):1122–8. doi:.https://doi.org/10.1002/art.1780330810
  8. Nienhuis PH, Sandovici M, Glaudemans AW, Slart RH, Brouwer E. Visual and semiquantitative assessment of cranial artery inflammation with FDG-PET/CT in giant cell arteritis. Semin Arthritis Rheum. 2020;50(4):616–23. doi:.https://doi.org/10.1016/j.semarthrit.2020.04.002
  9. Unizony SH, Dasgupta B, Fisheleva E, Rowell L, Schett G, Spiera R, et al. Design of the tocilizumab in giant cell arteritis trial. Int J Rheumatol. 2013;2013:912562. doi:.https://doi.org/10.1155/2013/912562
  10. Bardi M, Diamantopoulos AP. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice summary. Radiol Med (Torino). 2019;124(10):965–72. doi:.https://doi.org/10.1007/s11547-019-01058-0
  11. Slart RHJA ; Writing group; Reviewer group; Members of EANM Cardiovascular; Members of EANM Infection & Inflammation; Members of Committees, SNMMI Cardiovascular; Members of Council, PET Interest Group; Members of ASNC; EANM Committee Coordinator. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging. 2018;45(7):1250–69. doi:.https://doi.org/10.1007/s00259-018-3973-8
  12. Aschwanden M, Daikeler T, Kesten F, Baldi T, Benz D, Tyndall A, et al. Temporal artery compression sign--a novel ultrasound finding for the diagnosis of giant cell arteritis. Ultraschall Med. 2013;34(1):47–50. doi:.https://doi.org/10.1055/s-0032-1312821
  13. Aschwanden M, Kesten F, Stern M, Thalhammer C, Walker UA, Tyndall A, et al. Vascular involvement in patients with giant cell arteritis determined by duplex sonography of 2x11 arterial regions. Ann Rheum Dis. 2010;69(7):1356–9. doi:.https://doi.org/10.1136/ard.2009.122135
  14. Berger CT, Sommer G, Aschwanden M, Staub D, Rottenburger C, Daikeler T. The clinical benefit of imaging in the diagnosis and treatment of giant cell arteritis. Swiss Med Wkly. 2018;148:w14661. doi:.https://doi.org/10.4414/smw.2018.14661
  15. Imfeld S, Aschwanden M, Rottenburger C, Schegk E, Berger CT, Staub D, et al. [18F]FDG positron emission tomography and ultrasound in the diagnosis of giant cell arteritis: congruent or complementary imaging methods? Rheumatology (Oxford). 2020;59(4):772–8. doi:.https://doi.org/10.1093/rheumatology/kez362

Most read articles by the same author(s)

1 2 > >>