![Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F3777.jpg&w=3840&q=50)
Vascular uptake on 18F-FDG PET/CT predicts relapse in new-onset PMR
Ningqi Dai1, Xinyi Sun2, Linzi Meng1
1Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Objective:
In this study, we utilize 18F-fluorodeoxyglucose (FDG) PET/CT to assess vascular involvement in patients with PMR, aiming to clarify its role in identifying subclinical GCA and its potential association with disease relapse.
Methods:
We conducted a retrospective cohort study of 80 patients diagnosed with PMR who underwent PET/CT scanning at Ruijin hospital from September 2015 to December 2023. Based on PET/CT findings, patients were divided into two groups: those with vascular involvement and those without. We compared baseline clinical characteristics, treatments and relapse rates between the two groups. Multivariate Cox regression analysis was performed to identify independent predictors of relapse.
Results:
In our cohort, 14 patients (14/80, 17.5%) were identified as having subclinical GCA, with 93% (13/14) exhibiting extracranial vessel involvement. Relapse rates were significantly higher in patients with subclinical GCA compared with those with isolated PMR (71% vs 29%, P = 0.003). Vascular involvement was identified as a strong predictor of relapse with a hazard ratio (HR) of 3.731 (95% CI: 1.705-8.164). Conversely, arthralgia appeared to be a protective factor against relapse with a HR of 0.325 (95% CI: 0.148-0.711).
Conclusion:
Our findings highlight vascular involvement as a critical predictor of relapse in PMR, underscoring the utility of 18F-FDG PET/CT in detecting subclinical GCA and predicting prognosis. Further research is needed to establish screening protocols and optimize relapse prevention strategies in this population.
Insights
Vascular involvement in polymyalgia rheumatica (PMR) patients, detected by 18F-FDG PET/CT, predicts disease relapse and identifies subclinical giant cell arteritis (GCA). This imaging tool aids in prognosis and relapse prevention strategies.
Area of Science:
- Rheumatology
- Nuclear Medicine
- Vascular Imaging
Background:
- Polymyalgia rheumatica (PMR) can be associated with subclinical giant cell arteritis (GCA).
- Identifying patients at high risk for PMR relapse is crucial for effective management.
- 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a valuable imaging modality for assessing vascular inflammation.
Purpose of the Study:
- To evaluate the utility of 18F-FDG PET/CT in detecting vascular involvement in PMR patients.
- To determine if vascular involvement is associated with subclinical GCA and disease relapse in PMR.
- To identify predictors of relapse in PMR patients.
Main Methods:
- Retrospective cohort study of 80 PMR patients undergoing 18F-FDG PET/CT.
- Patients categorized into groups based on vascular involvement detected by PET/CT.
- Comparison of clinical characteristics, treatments, and relapse rates; multivariate Cox regression analysis for relapse predictors.
Main Results:
- 17.5% of PMR patients showed vascular involvement, with 93% of these having extracranial vessel involvement, suggestive of subclinical GCA.
- Relapse rates were significantly higher in patients with subclinical GCA (71%) versus isolated PMR (29%).
- Vascular involvement (HR 3.731) strongly predicted relapse, while arthralgia showed a protective effect (HR 0.325).
Conclusions:
- Vascular involvement detected by 18F-FDG PET/CT is a critical predictor of relapse in PMR.
- 18F-FDG PET/CT is useful for identifying subclinical GCA and predicting prognosis in PMR patients.
- Further research is warranted to develop screening protocols and optimize relapse prevention strategies.
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