ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2145

Diagnostic Performance and Disease Activity Assessment By FDG-PET in Large-Vessel Vasculitis: A Systematic Literature Review and Meta-Analysis

Michael Soussan1, Patrick Nicolas2, Catherine Schramm3, Sandrine Katsahian3, Veronique Eder4, Olivier Fain5 and Arsene Mekinian6, 1Nuclear Medicine, Avicennes Hospital, Bobigny, France, 2Pharmacology, Avicenne Hospital, 93000, France, 3Inserm U1138, Centre de Recherche des Cordeliers, Equipe 22, Paris 5, Paris 6, Paris, France, paris, France, 4Nuclear Medicine, Avicenne Hospital, Bobigny, France, 5Hôpital Saint Antoine, DHU i2B, Service de Médecine Interne, paris, France, 6Internal Medicine, DHUi2B Saint Antoine Hospital, paris, France

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Title: Imaging of Rheumatic Diseases: Various Imaging Techniques

Session Type: Abstract Submissions (ACR)

Background/Purpose: FDG-PET is increasingly used in the work up of large-vessel vasculitis (LVV). The purpose of this study is to perform a systematic review and meta-analysis of the value of FDG-PET for the diagnosis of LVV.

Methods: MEDLINE and Cochrane Library were searched for articles that evaluated the value of FDG-PET in LVV, from 01/2000 to 12/2013. Inclusion criteria were: American College of Rheumatology (ACR) criteria for the diagnosis of Giant Cell Arteritis (GCA) or Takayasu Arteritis (TA), definition of PET positivity threshold, and > 4 cases included. Data were pooled to compare clinical/biological data and PET results. Sensitivity and specificity of FDG-PET for the diagnosis of LVV were calculated from each included individual study, then pooled for meta-analyses with a random effects model.

Results: Were included 21 studies with a total of 413 patients and 299 controls. Pooled sensitivity and specificity of FDG-PET for the diagnosis of LVV were 0.77 (95% CI,0.69- 0.83) and 0.95 (95% CI,0.92-0.95), respectively. When GCA subgroup was considered, sensitivity increased to 0.9 (95% CI,0.79-0.96) and specificity to 0.98 (95% CI,0.94-0.99), with a decrease in inconsistency (I-square). Pooled sensitivity and specificity of FDG-PET to assess TA disease activity were 0.87 (95% CI,0.78- 0.93) and 0.73 (95% CI,0.63- 0.81), respectively. Sub-analysis of studies using NIH criteria for disease activity assessment, showed that the specificity increased to 0.84 [0.73 ;0.92], with a decrease in inconsistency. High vascular uptake (> liver uptake) was the most reliable PET threshold for the diagnosis of aortitis. As a limitation, PET technology and threshold used to define the presence of vascular inflammation varied among the studies. Furthermore, no systematic comparison with conventional cross imaging was available.

Conclusion: FDG-PET has an overall valuable performance for the diagnosis of LVV, especially for GCA, and for the assessment of the activity in TA. Further studies are needed to better determine the utility of PET for management of LVV.

Disclosure:

M. Soussan,
None;

P. Nicolas,
None;

C. Schramm,
None;

S. Katsahian,
None;

V. Eder,
None;

O. Fain,
None;

A. Mekinian,
None.

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