Steroid Bolus Leads to a Negative 18f-FDG PET/CT Scan in Large Vessel Vasculitis. Data from a Multicenter Giant Cell Arteritis Cohort Database

Paula Estrada¹, Patricia Moya², Hector Corominas³, Delia Reina⁴, Dacia Cerdà⁴, Daniel Roig Vilaseca⁴, Vanessa Navarro⁴, Sergi Heredia⁴ and Francisco Javier Narváez⁵, ¹Rheumatology, Hospital Moisès Broggi-Hospital General de L´Hospitalet. Consorci Sanitari Integral, Barcelona, Spain, ²Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, ³Rheumatology, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain, ⁴Rheumatology, Hospital Moisès Broggi-Hospital General de L´Hospitalet. Consorci Sanitari Integral,, barcelona, Spain, ⁵Rheumatology Department, Hospital de Bellvitge. Barcelona. Spain, L’Hospitalet de Llobregat, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: 18FDG PET/CT scan, giant cell arteritis, Glucocorticoids and polymyalgia rheumatica

Session Information

Date: Tuesday, October 23, 2018

Title: Imaging of Rheumatic Diseases Poster III: Other Modalities

Session Type: ACR Poster Session C

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

Background/Purpose: Giant cell arteritis (GCA) and polymialgia rheumatica (PMR) are overlapping inflammatory diseases. Large Vessel Vasculitis (LVV) is frequently present in any of the two subsets¹. In some scenarios where complications such as visual loss or stroke are present, treatment with steroids bolus is a common practice. Imaging studies when suspecting LVV are as sensible and more easily available than temporal artery biopsy². 18f-FDG PET/CT is useful to confirm mural inflammation in extracranial arteries to support diagnosis of LVV. Beside this rationale, some questions still remain unclear regarding the involvement of PET/CT in patients receiving steroids³.

Methods: Multicenter, retrospective, descriptive analysis of 18f-FDG PET/CT in 69 patients who met 2010 ACR criteria for GCA. Demographic data, cumulative GC prior to PET/CT, and vascular territories affected were collected. Patients included were either new diagnosis or those who had previous diagnosis of GCA or PMR, who had a relapse or complicated follow-up. PET/CT scan was reported either positive or negative for LVV for any of 8 major vascular territories: ascending aorta, arotic arch, descending thoracic aorta, abdominal aorta, carotids, subclavian/ braquiocephalic, axillary/humeral and iliac/femoral arteries. Statistic analysis was done with c² with Yates’ correction and exact Fischer’s test.

Results: Mean age: 72 years ± 5 yo, 68%, women. Territories mostly affected: thoracic aorta (75%), iliac/femoral arteries (54.2%) and supraaortic vessels (47.9%). In general, GC seemed to be associated with the possibility of a negative PET/CT scan. A subanalysis among patients allowed to classify into 3 groups: (1) no previous steroids (2) previous acummulated GC (3) steroid bolus previous to PET/CT. Group 2, showed a mean accumulated dose of GC 2,908.4 mg ± 339. A 31.8% of PET/CT scans were negative, interestingly 84% corresponded to the group of patients who had received a steroid bolus prior to the PET/TC (p 0.01) (Table 1).

	positive PET/CT	negative PET/CT
Group 1, n= 29	27 ( 93.1%)	2 (6.9%)
Group 2, n= 27	18(66.7%)	9(33.3&)
Group 3, n=13	2(15.4%)	11(84.6%)

Conclusion:

Conclusions: Data from our multicenter cohort of LVV showed that thoracic aorta was the most frequent vessel affected, as expected. When steroid bolus was given, there was a strong association with a negative PET/CT scan, compared with patients who received either a variable dose or any dose of steroids. Our results confirmed something expected beforehand, but not yet described in a large cohort of patients.

doi:10.1093/rheumatology/kew273
doi:10.1136/annrheumdis-2017-212649
doi:10.3899/jrheum.170138

Disclosure: P. Estrada, None; P. Moya, None; H. Corominas, None; D. Reina, None; D. Cerdà, None; D. Roig Vilaseca, None; V. Navarro, None; S. Heredia, None; F. J. Narváez, None.

To cite this abstract in AMA style:

Estrada P, Moya P, Corominas H, Reina D, Cerdà D, Roig Vilaseca D, Navarro V, Heredia S, Narváez FJ. Steroid Bolus Leads to a Negative 18f-FDG PET/CT Scan in Large Vessel Vasculitis. Data from a Multicenter Giant Cell Arteritis Cohort Database [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/steroid-bolus-leads-to-a-negative-18f-fdg-pet-ct-scan-in-large-vessel-vasculitis-data-from-a-multicenter-giant-cell-arteritis-cohort-database/. Accessed .

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