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DOI: 10.1055/a-2053-7191
PET-Derived Increased Inflammation in Large Vessels is linked to Relapse-Free Survival in Patients with Giant Cell Arteritis
Der Uptake im FDG-PET in großen Gefäßabschnitten ist mit dem rezidivfreien Überleben bei Riesenzellarteriitis assoziiert
Abstract
Background Despite anti-inflammatory treatment, patients with giant cell arteritis (GCA) experience relapse. We aimed to determine respective relapse predictors focusing on [18F]fluorodeoxyglucose ([18F]FDG)-PET-based parameters.
Material and Methods 21 therapy-naïve GCA patients received [18F]FDG-PET/CT. Patients were divided in two groups: those who relapsed during course of disease and those who did not. Median follow up was 15 months. [18F]FDG-PET/CT was analyzed for visual (PET vascular activity score [VAS]) and quantitative parameters, including Target-to-background-Ratio with liver (TBRliver) and jugular vein (TBRjv) serving as reference tissues. In addition, clinical parameters were tested.
Results 8/21 (38.1 %) had relapse. Clinical parameters could not significantly discriminate between relapse vs no-relapse, including age (p = 0.9) or blood-based inflammatory markers (white blood cell counts [WBC] and c-reactive protein [CRP], p = 0.72, each). PETVAS score could also not differentiate between respective subgroups (p = 0.59). In a quantitative assessment, TBRjv demonstrated a trend towards significance (p = 0.28). TBRliver, however, separated between patients with and without relapse (p = 0.03).
Conclusion [18F]FDG PET quantification of vessels may be useful to identify GCA patients prone to relapse during follow-up.
Zusammenfassung
Hintergrund Patienten mit Riesenzellarteriitis (RZA) erleiden trotz immunsuppressiver Therapie häufig ein Rezidiv (Relapse). Wir haben deshalb untersucht, ob [18F]Fluordeoxyglucose ([18F]FDG) -PET-basierte Parameter geeignet sein könnten, um einen Relapse vorhersagen zu können.
Material und Methoden 21 therapienaive RZA-Patient*innen erhielten ein [18F]FDG-PET/CT. Die Patient*innen wurden dann in 2 Gruppen eingeteilt: Relapse und Non-Relapse. Die mediane Nachbeobachtungszeit betrug 15 Monate. Die [18F]FDG-PET/CTs wurden visuell (PET vascular activity score, VAS) und quantitativ analysiert, einschließlich der Target-to-Background-Ratio (TBR), wobei die Uptakes im Lebergewebe (TBRLeber) und der Jugularvene (TBRjv) als Referenz herangezogen wurden. Zusätzlich wurden klinische Parameter zum Baseline-Zeitpunkt untersucht.
Ergebnisse 8/21 (38,1 %) erlitten einen Relapse. Klinische Parameter konnten nicht zwischen Relapse und Non-Relapse unterscheiden (Alter (p = 0,9) bzw. Entzündungsmarker (Leukozyten und C-reaktives Protein, jeweils p = 0,72)). Auch der PETVAS-Score konnte nicht zwischen den beiden Gruppen differenzieren (p = 0,59). In einer quantitativen Analyse der PET zeigte die TBRjv einen Trend zur Signifikanz (p = 0,28), wohingegen die TBRLeber zwischen Relapse und Non-Relapse differenzieren konnte (p = 0,03).
Schlussfolgerung Eine quantitative Auswertung des [18F]FDG-PET/CT könnte helfen, um RZA-Patient*innen zu detektieren, die einen Relapse unter Therapie erleiden.
Publication History
Received: 06 November 2022
Accepted: 14 February 2023
Article published online:
04 September 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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