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.
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 June 5, 2020.
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