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Abstract Number: 262

FDG PET/CT Visualization of Inflammation in Temporal and Maxillary Arteries in Treatment-Naive GCA Patients

Berit Dalsgaard Nielsen1,2, Ib Tønder Hansen3,4, Kresten Krarup Keller5, Philip Therkildsen6,7, Ellen-Margrete Hauge6,8 and Lars Christian Gormsen9, 1Rheumatology, Department of Rheumatology, Aarhus University Hospital, Århus C, Denmark, 2Clnical Medicine, Department of Clinical Medicine, Aarhus University Hospital, Århus N, Denmark, 3Clinical Medicine, Department of Clinical Medicine, Aarhus University Hospital, Århus N, Denmark, 4Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, 5Rheumatology, Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, 6Clinical medicine, Department of Clinical Medicine, Aarhus University Hospital, Århus N, Denmark, 7Department of Rheumatology, Aarhus University Hospital, Aarhus C, Denmark, 8Department of Rheumatology, Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, 9Nuclear Medicine and PET Center, Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Århus C, Denmark

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Diagnostic imaging, giant cell arteritis and positron emission tomography (PET)

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Session Information

Date: Sunday, November 5, 2017

Session Title: Imaging of Rheumatic Diseases Poster I

Session Type: ACR Poster Session A

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

Background/Purpose:

Fluorine-18-fluorodeoxyglucose (FDG) PET/CT is increasingly used to diagnose large vessel GCA (LV-GCA), but has previously been considered unable to reveal inflammation in temporal arteries due to limited spatial resolution. However, the arteritic pattern in GCA is heterogeneous and additionally may not always uniformly involve the entire vessel, rendering interpretation of the PET images difficult. An increased FDG uptake in branches of the external carotic artery, i.e. the temporal (TA) and maxillary arteries (MA), may therefore add to diagnostic specificity.

 

Methods:

21 patients fulfilling the ACR criteria of GCA were identified from a LV-GCA cohort (table 1). Laboratory tests, temporal artery ultrasound (US) and FDG PET/CT (Siemens Biograph 64) were performed prior to treatment.

An experienced nuclear medicine physician performed blinded assessment of FDG uptake in TA and MA. FDG uptake was visually scored on a 4-point scale (a.m. Meller1: 1; ≤ blood pool, 2; > blood pool, ≤ liver, 3; ≥ liver, 4; ≥ 2xliver), where score ≥2 was considered indicative of inflammation. In addition, mean and max standardized uptake values (SUVmean, SUVmax; 20 hottest interconnected pixels) and target to background ratio (TBR=SUVmax(artery)/SUVmean(venousblood)) were recorded for each vessel based on volumes of interest drawn on the PET images.

Correlations were calculated using Spearman’s test. Mann–Whitney U test or Student t test, when applicable, were used for quantitative data. Associations between two categorical variables were evaluated using Fisher’s exact test.

Results:

FDG uptake in cranial arteries was detectable in 20/21 patients; 12/21 TA and 20/21 MA. In 11 patients, at least one of the arteries was categorized with a Meller score≥2 indicating significant inflammation. SUVs and TBRs are shown in table 1. SUVs and TBR correlated with Meller scores.

In the 3 patients with negative TA US (n=2 biopsy positive) and in the 2 patients with negative TA biopsies (n=1 US positive), FDG uptake in TA and MA was either not detectable or with a Meller score of 1. Meller score in the TA correlated with the degree of inflammation (none, <transmural, transmural) in the TA biopsy (rho=0.64, p<0.01). Patients with a TA or MA Meller score≥2 were more likely to have severe cranial symptoms (p=0.02), jaw claudication (p<0.02), had a shorter disease duration prior to diagnosis (median 8 vs 17 weeks, p<0.02) and were younger (median 65 vs 69 years, p<0.01) than patients with Meller score<2. However, they did not differ in gender or CRP at time of diagnosis.

 

Conclusion:

Increased FDG uptake in the cranial arteries of GCA patients is frequent, correlated to histological inflammation and subjective symptoms and detectable by normal PET/CT systems. It may add to the diagnostic accuracy of 18F-FDG PET/CT in GCA and should not be overlooked by reading physicians.

 

 

 

Table 1

Baseline characteristics of patients fulfilling ACR criteria for GCA

No. patients

21

Age, median (range)

68 (60-84)

Gender, females no.

13

CRP, mean (95% CI)

82 (65; 104)

Temporal artery biopsy positive, no

16/18

Temporal artery ultrasound positive

18/21

Temporal artery PET characteristics

SUVmean

2.18 (1.69; 2.68)

SUVmax

3.10 (2.27; 3.94)

TBR

1.95 (1.47; 2.48)

Maxillary artery PET characteristics

SUVmean

2.21 (1.77; 2.64)

SUVmax

2.86 (2.21; 3.71)

TBR

2.04 (1.49;2.58)

Patients fullfilling ACR criteria for GCA were identified in a prospective cohort of 24 large-vessel GCA patients. Inclusion criteria in the cohort were: Age>50 years, CRP>15 or ESR>40, either cranial symptoms of GCA, abrupt new-onset of extremity claudication or weightloss>5kg or fever>38 for more than 3 weeks and PET proven large vessel involvement (FDG uptake higher than liver FDG uptake in aorta and/or supraaortic branches).

References

1. Stellingwerff MD et al. Medicine 2015

 

 


Disclosure: B. D. Nielsen, None; I. Tønder Hansen, None; K. K. Keller, None; P. Therkildsen, None; E. M. Hauge, None; L. C. Gormsen, None.

To cite this abstract in AMA style:

Nielsen BD, Tønder Hansen I, Keller KK, Therkildsen P, Hauge EM, Gormsen LC. FDG PET/CT Visualization of Inflammation in Temporal and Maxillary Arteries in Treatment-Naive GCA Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/fdg-petct-visualization-of-inflammation-in-temporal-and-maxillary-arteries-in-treatment-naive-gca-patients/. Accessed January 27, 2023.
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