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Comparative study of 18F-FDG PET/CT and CT angiography in detection of large vessel vasculitis
M Moragas Solanes1, M Andreu Magarolas2, J C Martín Miramon1
1Servicio de Medicina Nuclear. Parc Taulí Hospital Universitario, Sabadell (Barcelona), España.
Insights
¹⁸F-FDG PET/CT demonstrates superior sensitivity and specificity for diagnosing large vessel vasculitis (LVV) compared to CT angiography. This study highlights ¹⁸F-FDG PET/CT as a potential first-line imaging technique for extracranial LVV detection.
Area of Science:
- Nuclear Medicine
- Radiology
- Vascular Imaging
Background:
- Large vessel vasculitis (LVV) diagnosis requires accurate imaging of extracranial arteries.
- Current imaging modalities have limitations in sensitivity and specificity for LVV detection.
Purpose of the Study:
- To compare the diagnostic performance of ¹⁸F-FDG PET/CT and CT angiography (CTangio) in identifying extracranial large vessel involvement in patients with suspected LVV.
- To evaluate the potential of ¹⁸F-FDG PET/CT as a primary diagnostic tool for LVV.
Main Methods:
- Retrospective review of 59 patients with suspected LVV who underwent both ¹⁸F-FDG PET/CT and CTangio.
- ¹⁸F-FDG PET/CT analysis included qualitative and quantitative assessments (SUVmax ratio).
- CTangio was evaluated for mural thickening, enhancement, and structural changes.
Main Results:
- ¹⁸F-FDG PET/CT showed high specificity (97.2%) and excellent sensitivity (95.6%) for LVV.
- CTangio had lower sensitivity (60.9%) but high specificity (97.2%).
- ¹⁸F-FDG PET/CT exhibited a high negative predictive value (97.2%), while CTangio had a high false-negative rate (39.1%).
Conclusions:
- ¹⁸F-FDG PET/CT is a highly effective imaging technique for detecting and assessing the extent of LVV.
- ¹⁸F-FDG PET/CT should be considered the first-line imaging modality for extracranial LVV.
- CTangio may be beneficial as an adjunct in specific cases like Takayasu arteritis or severe/long-standing vasculitis to detect complications.
Objective:
Compare 18F-FDG PET/CT and CTangio in the diagnosis of extracraneal large vessel involvement in patients with suspicion of large vessel vasculitis (LVV).
Material And Methods:
A retrospective database reviewed 59 patients with clinical suspicion of LVV undergoing 18F-FDG PET/CT and CTangio. In 55 patients PET/TC and CTangio were done simultaneously in the same machine and in 4 patients with a scan interval of<1 month. PET/CT analyses included qualitatively and quantitative analysis (ratio SUVmax 18F-FDG vessel/SUVmax liver). CTangio was assessed for concentric mural thickening, contrast wall enhancement and structural vascular changes as potential complications of vasculitis.
Results:
18F-FDG PET/CT and CTangio show high specificity (97.2%) for LVV diagnosis, with an excellent sensitivity for 18F-FDG PET/CT (95.6%) and lower for CTangio (60.9%), which leads to a high negative predictive value for 18F-FDG PET/CT (97.2%) and a high false negative rate for CTangio (39.1%). A 70% concordance between 18F-FDG PET/CT and CTangio was obtained (Kappa index 0.70± 0.095 (P<.001).
Conclusion:
The results show the greater potential of 18F-FDG PET/CT for the detection and extension of LVV. Therefore, 18F-FDG PET/CT should be exploited to the maximum and consider as the first line imaging technique in the extracranial diagnosis of LVV and its possible association with polymyalgia rheumatica. The addition of CTangio could be more indicated in patients with Takayasu arteritis and in long-standing and/or severe vasculitis since it increases the accuracy in the detection of possible vascular complications.
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