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Giant-cell arteritis: concordance study between aortic CT angiography and FDG-PET/CT in detection of large-vessel
Hubert de Boysson1, Anael Dumont2, Eric Liozon3
1Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France. deboysson-h@chu-caen.fr.
Insights
Aortic CT angiography (CTA) and FDG-PET/CT show similar results for detecting large-vessel involvement in giant-cell arteritis (GCA) per patient. However, FDG-PET/CT is superior for detailed segment analysis, particularly for aortic branch inflammation.
Area of Science:
- Vascular Imaging
- Rheumatology
- Nuclear Medicine
Background:
- Giant-cell arteritis (GCA) is a large-vessel vasculitis.
- Accurate detection of large-vessel involvement is crucial for GCA diagnosis and management.
- Imaging modalities like CT angiography (CTA) and FDG-PET/CT are used to assess vascular inflammation.
Purpose of the Study:
- To evaluate the concordance between aortic CTA and FDG-PET/CT in identifying large-vessel involvement in GCA patients at diagnosis.
- To compare the diagnostic performance of CTA and FDG-PET/CT in different analytical approaches (per-patient vs. per-segment).
Main Methods:
- A multicenter cohort of 28 GCA patients diagnosed between 2010-2015 was analyzed.
- Patients underwent both FDG-PET/CT and aortic CTA before or within 10 days of treatment initiation.
- Concordance was assessed using Cohen's kappa index in per-patient and per-segment analyses.
Main Results:
- Per-patient analysis showed high concordance (0.85) between CTA and FDG-PET/CT for detecting large-vessel involvement.
- FDG-PET/CT identified more involved vascular segments (median 5) compared to CTA (median 3) (p=0.03).
- CTA demonstrated high sensitivity (95%) and specificity (100%) versus FDG-PET/CT in per-patient analysis, while per-segment analysis showed 61% sensitivity and 97.9% specificity for CTA.
Conclusions:
- Both CTA and FDG-PET/CT effectively detect large-vessel involvement in GCA on a per-patient basis.
- FDG-PET/CT offers superior performance in per-segment analysis, especially for detecting inflammation in the aorta's branches.
- The findings suggest complementary roles for CTA and FDG-PET/CT in GCA imaging.
Purpose:
The purpose of our study was to assess the concordance of aortic CT angiography (CTA) and FDG-PET/CT in the detection of large-vessel involvement at diagnosis in patients with giant-cell arteritis (GCA).
Methods:
We created a multicenter cohort of patients with GCA diagnosed between 2010 and 2015, and who underwent both FDG-PET/CT and aortic CTA before or in the first ten days following treatment introduction. Eight vascular segments were studied on each procedure. We calculated concordance between both imaging techniques in a per-patient and a per-segment analysis, using Cohen's kappa concordance index.
Results:
We included 28 patients (21/7 women/men, median age 67 [56-82]). Nineteen patients had large-vessel involvement on PET/CT and 18 of these patients also presented positive findings on CTA. In a per-segment analysis, a median of 5 [1-7] and 3 [1-6] vascular territories were involved on positive PET/CT and CTA, respectively (p = 0.03). In qualitative analysis, i.e., positivity of the procedure suggesting a large-vessel involvement, the concordance rate between both procedures was 0.85 [0.64-1]. In quantitative analysis, i.e., per-segment analysis in both procedures, the global concordance rate was 0.64 [0.54-0.75]. Using FDG-PET/CT as a reference, CTA showed excellent sensitivity (95%) and specificity (100%) in a per-patient analysis. In a per-segment analysis, sensitivity and specificity were 61% and 97.9%, respectively.
Conclusions:
CTA and FDG-PET/CT were both able to detect large-vessel involvement in GCA with comparable results in a per-patient analysis. However, PET/CT showed higher performance in a per-segment analysis, especially in the detection of inflammation of the aorta's branches.
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