Session Information
Date: Tuesday, October 23, 2018
Session 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
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 10). 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 September 24, 2021.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - 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/