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Diagnosis of large-vessel vasculitis using [18F]-FDG PET-CT

Diagnosi di vasculite dei grandi vasi con 18F-FDG PET-TC

  • Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The aim of this retrospective study was to assess the performance of fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography ([18F]-FDG PET-CT) for diagnosing large-vessel vasculitis (LVV) for a subset of patients at increased risk of rheumatic/immune diseases, taking into account concurrent immunosuppressive therapy.

Materials and methods

The study comprised 64 rheumatological referrals with suspected LVV; half of the patients were on immunosuppressive therapy at the time of examination. The final diagnosis of LVV was established in 31 patients. To evaluate vascular uptake, the nuclear medicine physician employed both a semiquantitative method based on standardised uptake value (SUV) determination and a qualitative method based on a visual score from 0 to 3 on the maximum intensity projection (MIP) reformats. Finally, a joint assessment was carried out between the nuclear medicine physician and the reporting radiologist, in which PET metabolic data were re-evaluated taking into account clinical data and baseline CT scans. McNemar’s test was used to compare four types of analysis: semiquantitative (cutoff ≥2.4), qualitative with standard cutoff (grade ≥2), qualitative with reduced cutoff (grade ≥1) and joint.

Results

Semiquantitative analysis (sensitivity 74.19%, specificity 78.78%, accuracy 76.56%) and qualitative analysis with standard cutoff (sensitivity 64.51%, specificity 84.84%, accuracy 75.00%) showed no statistical difference for the diagnosis of LVV, whereas qualitative analysis with lower cutoff (sensitivity 93.54%, specificity 75.75%, accuracy 84.37%) proved to be better than the other two. Joint analysis (sensitivity 93.54%, specificity 93.93%, accuracy 93.75%) introduced some corrective elements not present in the qualitative analysis with cutoff ≥1 and therefore increased specificity significantly.

Conclusions

Interpretation of PET-CT should be individualised for each patient by taking into account clinical-radiological and metabolic data. To this end, cooperation between the nuclear medicine specialist and the radiologist is essential.

Riassunto

Obiettivo

Lo scopo di questo studio retrospettivo è stato di verificare la performance diagnostica della PET-TC con 18F-FDG nella ricerca di vasculite dei grandi vasi (VGV) in un campione di pazienti a elevato sospetto reumatologico, considerando l’influenza della concomitante terapia immunosoppressiva.

Materiali e metodi

Sono stati inclusi 64 pazienti inviati dal reumatologo per sospetta VGV; metà dei pazienti al momento dell’esame erano in terapia immunosoppressiva. La diagnosi finale di VGV è stata stabilita in 31 su 64 pazienti. Per valutare la captazione vascolare il medico nucleare ha utilizzato sia il metodo semi-quantitativo, basato sulla misurazione del SUV, che il metodo qualitativo, assegnando un punteggio visuale da 0 a 3 sulle ricostruzioni MIP. Infine, è stato formulato un giudizio “collegiale” insieme al radiologo, rivalutando i dati metabolici PET alla luce delle informazioni cliniche e delle immagini TC. Quattro tipi di analisi sono state confrontate utilizzando il test di McNemar: semi-quantitativa (cutoff ≥2,4), qualitativa con soglia standard (grado ≥2), qualitativa con soglia inferiore (grado ≥1) e collegiale.

Risultati

L’analisi semiquantitativa (sens 74,19%, spec 78,78%, acc 76,56%) e quella qualitativa con soglia standard (sens 64,51%, spec 84,84%, acc 75,00%) non hanno presentato differenze statisticamente significative nella diagnosi di VGV, mentre il metodo qualitativo con soglia inferiore (sens 93,54%, spec 75,75%, acc 84,37%) è risultato superiore a entrambe. L’analisi collegiale (sens 93,54%, spec 93,93%, acc 93,75%), introducendo alcuni elementi correttivi rispetto al metodo qualitativo con soglia ≥1, ha consentito di aumentare significativamente la specificità.

Conclusioni

L’interpretazione dell’esame PET-TC deve essere individualizzata per il singolo paziente, basandosi sull’integrazione tra i dati clinico-radiologici e l’imaging metabolico: a tale fine è essenziale la collaborazione tra medico nucleare e radiologo.

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Authors and Affiliations

  1. Dipartimento di Radiodiagnostica, APSS di Trento, Trento, Italy

    U. Rozzanigo, A. Pellegrin, M. Centonze & G. Casagranda

  2. Medicina Nucleare, Ospedale Santa Chiara, Largo Medaglie d’Oro 9, 38122, Trento, Italy

    M. Erini & D. Donner

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  1. U. Rozzanigo
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  2. A. Pellegrin
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  3. M. Centonze
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Correspondence to U. Rozzanigo.

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Rozzanigo, U., Pellegrin, A., Centonze, M. et al. Diagnosis of large-vessel vasculitis using [18F]-FDG PET-CT. Radiol med 118, 633–647 (2013). https://doi.org/10.1007/s11547-012-0901-z

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  • DOI: https://doi.org/10.1007/s11547-012-0901-z

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