Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
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![](https://www.thieme-connect.de/media/10.1055-s-00034924/202304/lookinside/thumbnails/nuk-20537191_10-1055-a-2053-7191-1.jpg)
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/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ. et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum 2009; 61: 1454-1461 DOI: 10.1002/art.24459.
- 2 Hellmich B, Agueda A, Monti S. et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2020; 79: 19-30 DOI: 10.1136/annrheumdis-2019-215672.
- 3 Aussedat M, Lobbes H, Samson M. et al. Epidemiology of major relapse in giant cell arteritis: A study-level meta-analysis. Autoimmunity reviews 2022; 21: 102930 DOI: 10.1016/j.autrev.2021.102930.
- 4 Broder MS, Sarsour K, Chang E. et al. Corticosteroid-related adverse events in patients with giant cell arteritis: A claims-based analysis. Semin Arthritis Rheum 2016; 46: 246-252 DOI: 10.1016/j.semarthrit.2016.05.009.
- 5 Aouba A, Gonzalez Chiappe S, Eb M. et al. Mortality causes and trends associated with giant cell arteritis: analysis of the French national death certificate database (1980-2011). Rheumatology (Oxford) 2018; 57: 1047-1055 DOI: 10.1093/rheumatology/key028.
- 6 Tombetti E, Hysa E, Mason JC. et al. Blood Biomarkers for Monitoring and Prognosis of Large Vessel Vasculitides. Curr Rheumatol Rep 2021; 23: 17 DOI: 10.1007/s11926-021-00980-5.
- 7 Werner RA, Thackeray JT, Diekmann J. et al. The Changing Face of Nuclear Cardiology: Guiding Cardiovascular Care Toward Molecular Medicine. Journal of Nuclear Medicine 2020; 61: 951-961 DOI: 10.2967/jnumed.119.240440.
- 8 Coath FL, Mukhtyar C. Ultrasonography in the diagnosis and follow-up of giant cell arteritis. Rheumatology (Oxford) 2021; 60: 2528-2536 DOI: 10.1093/rheumatology/keab179.
- 9 Dejaco C, Ramiro S, Duftner C. et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018; 77: 636-643 DOI: 10.1136/annrheumdis-2017-212649.
- 10 Grayson PC, Alehashemi S, Bagheri AA. et al. (18) F-Fluorodeoxyglucose-Positron Emission Tomography As an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients With Large Vessel Vasculitis. Arthritis Rheumatol 2018; 70: 439-449 DOI: 10.1002/art.40379.
- 11 Schönau V, Roth J, Tascilar K. et al. Resolution of vascular inflammation in patients with new-onset giant cell arteritis: data from the RIGA study. Rheumatology (Oxford) 2021; 60: 3851-3861 DOI: 10.1093/rheumatology/keab332.
- 12 Slart R. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging 2018; 45: 1250-1269 DOI: 10.1007/s00259-018-3973-8.
- 13 Nielsen BD, Gormsen LC, Hansen IT. et al. Three days of high-dose glucocorticoid treatment attenuates large-vessel 18F-FDG uptake in large-vessel giant cell arteritis but with a limited impact on diagnostic accuracy. Eur J Nucl Med Mol Imaging 2018; 45: 1119-1128 DOI: 10.1007/s00259-018-4021-4.
- 14 Fröhlich M, Serfling S, Higuchi T. et al. Whole-Body [(18)F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease. Diagnostics (Basel) 2021; 11 DOI: 10.3390/diagnostics11112073.
- 15 Guggenberger KV, Vogt ML, Rowe SP. et al. Clinical Utility of C-Reactive Protein and White Blood Cell Count for Scheduling an [18F]FDG PET/CT in Patients with Giant Cell Arteritis. Nuklearmedizin 2022; 61: 425-432 DOI: 10.1055/a-1830-7767.
- 16 Dumain C, Broner J, Arnaud E. et al. Patients’ Baseline Characteristics, but Not Tocilizumab Exposure, Affect Severe Outcomes Onset in Giant Cell Arteritis: A Real-World Study. J Clin Med 2022; 11 DOI: 10.3390/jcm11113115.
- 17 Werner RA, Koenig T, Diekmann J. et al. CXCR4-Targeted Imaging of Post-Infarct Myocardial Tissue Inflammation: Prognostic Value After Reperfused Myocardial Infarction. JACC Cardiovasc Imaging 2022; 15: 372-374 DOI: 10.1016/j.jcmg.2021.08.013.
- 18 Bellan M, Puta E, Croce A. et al. Role of positron emission tomography in the assessment of disease burden and risk of relapse in patients affected by giant cell arteritis. Clin Rheumatol 2020; 39: 1277-1281 DOI: 10.1007/s10067-019-04808-7.
- 19 Blockmans D, de Ceuninck L, Vanderschueren S. et al. Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients. Arthritis Rheum 2006; 55: 131-137 DOI: 10.1002/art.21699.
- 20 Lensen KD, Comans EF, Voskuyl AE. et al. Large-vessel vasculitis: interobserver agreement and diagnostic accuracy of 18F-FDG-PET/CT. Biomed Res Int 2015; 2015: 914692 DOI: 10.1155/2015/914692.
- 21 Dashora HR, Rosenblum JS, Quinn KA. et al. Comparing Semiquantitative and Qualitative Methods of Vascular (18)F-FDG PET Activity Measurement in Large-Vessel Vasculitis. J Nucl Med 2022; 63: 280-286 DOI: 10.2967/jnumed.121.262326.
- 22 Galli E, Muratore F, Mancuso P. et al. The role of PET/CT in disease activity assessment in patients with large vessel vasculitis. Rheumatology 2022; 61: 4809-4816 DOI: 10.1093/rheumatology/keac125.
- 23 Sammel AM, Hsiao E, Schembri G. et al. Cranial and large vessel activity on positron emission tomography scan at diagnosis and 6 months in giant cell arteritis. Int J Rheum Dis 2020; 23: 582-588 DOI: 10.1111/1756-185x.13805.
- 24 Rousset O, Rahmim A, Alavi A. et al. Partial Volume Correction Strategies in PET. PET Clin 2007; 2: 235-249 DOI: 10.1016/j.cpet.2007.10.005.