ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 820

Prognostic Value of Positron Emission Tomography in a Prospective, Longitudinal Cohort of Patients with Large Vessel Vasculitis

Peter C. Grayson1, Sara Alehashemi2, Armin Bagheri3, Ali Cahid Civelek4, Thomas Cupps5, Mariana J. Kaplan6, Ashkan Malayeri4, Peter A. Merkel7, Elaine Novakovich8, David A. Bluemke4 and Mark Ahlman4, 1National Institute of Arthritis, Musculoskeletal and Skin Disease (NIAMS), Bethesda, MD, 2Rheumatology, National Institutes of Health, Bethesda, MD, 3Vasculitis Translational Research Program, NIAMS, NIH, Bethesda, MD, 4Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, 5Rheumatology, Georgetown University, Bethesda, MD, 6NIAMS/NIH, Bethesda, MD, 7University of Pennsylvania, Philadelphia, MN, 8Systemic Autoimmunity Branch, NIAMS, National Institutes of Health, Bethesda, MD

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , , ,

Session Information

Date: Sunday, November 5, 2017

Title: Vasculitis Poster I: Large Vessel Vasculitis

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: While several studies have examined the potential of 18F-flurodeoxyglucose (FDG) positron emission tomography (PET) to help establish a diagnosis of large vessel vasculitis (LVV), the role of FDG-PET to monitor disease activity over time and predict clinical outcomes remains unclear. The study objective was to assess the clinical value of FDG-PET in a prospective cohort of patients with large-vessel vasculitis (LVV) and disease comparators.

Methods: Patients with Takayasu’s arteritis (TAK) and giant cell arteritis (GCA) were studied, along with a comparator group consisting of patients with hyperlipidemia, diseases that mimic LVV, and healthy controls. All participants underwent clinical evaluation and FDG-PET imaging, and patients with LVV underwent serial imaging at six-month intervals. Performance characteristics of FDG-PET interpretation were calculated to differentiate clinically active LVV from disease comparators and from clinical remission. Multivariable logistic regression in a mixed effects model was used to identify clinical factors associated with FDG-PET interpretation. A qualitative summary score based on global arterial FDG uptake in specific arterial territories was developed (the PET Vascular Activity Score – PETVAS). PETVAS was used to study associations between FDG-PET activity and clinical characteristics and to predict relapse.

Results: 170 FDG-PET scans were performed in 115 patients (LVV=56; comparators=59). FDG-PET differentiated patients with clinically active LVV and disease comparators with a sensitivity=85% (95%CI: 69-94%) and specificity=83% (95%CI: 71-91%). FDG-PET scans were interpreted as active vasculitis in the majority of 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 FDG-PET scan activity. Among 39 patients who underwent FDG-PET during remission, clinical relapse requiring a change in medical management was more common in patients with a high versus low PETVAS (45% versus 11%, p=0.03) over a median follow-up of 15 months.

Conclusion: FDG-PET provides information about vascular inflammation that is complimentary to, and unique from, clinical assessment in LVV. Use of FDG-PET to detect subclinical vascular inflammation in LVV during remission has prognostic value.

Disclosure: P. C. Grayson, None; S. Alehashemi, None; A. Bagheri, None; A. C. Civelek, None; T. Cupps, None; M. J. Kaplan, None; A. Malayeri, None; P. A. Merkel, None; E. Novakovich, None; D. A. Bluemke, None; M. Ahlman, None.

To cite this abstract in AMA style:

Grayson PC, Alehashemi S, Bagheri A, Civelek AC, Cupps T, Kaplan MJ, Malayeri A, Merkel PA, Novakovich E, Bluemke DA, Ahlman M. Prognostic Value of Positron Emission Tomography in a Prospective, Longitudinal Cohort of Patients with Large Vessel Vasculitis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/prognostic-value-of-positron-emission-tomography-in-a-prospective-longitudinal-cohort-of-patients-with-large-vessel-vasculitis/. Accessed .

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