18F-FDG uptake in main arterial branches of patients with large vessel vasculitis: visual and semiquantitative analysis
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ORIGINAL ARTICLE
18F-FDG uptake in main arterial branches of patients with large vessel vasculitis: visual and semiquantitative analysis Massimo Castellani1 • Manuela Vadrucci1,2 • Luigia Florimonte1 • Monica Caronni3 Riccardo Benti1 • Paola Bonara4
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Received: 15 October 2015 / Accepted: 29 March 2016 Ó The Japanese Society of Nuclear Medicine 2016
Abstract Objective Over the last decade, the contribution of 18FFDG (FDG) PET/CT imaging to the diagnosis of large vessel vasculitis has been widely investigated. The aim of this study was to evaluate a more extensive role for PET/ CT in grading vascular inflammation in patients with different clinical stages of disease. Methods The images of 66 PET/CT studies of 34 patients, performed at diagnosis and/or during follow-up were reviewed. FDG uptake in different regions of aorta and in its major branches was visually (regional Score: rS) and semiquantitatively (regional SUVmean: rSUV) assessed. The global vascular uptake was also evaluated for each study by summing all rSs (summed Score; sS) and averaging rSUVs (averaged SUV; aSUV). FDG uptake in 15 PET/CT studies of control age-matched subjects without signs or symptoms of vasculitis was also analyzed. Results Higher levels of regional and global FDG uptake were found at diagnosis in comparison with follow-up studies of 12 patients with complete longitudinal observation (p value range 0.0552–0.0026). In the latter group high
& Massimo Castellani [email protected] 1
Department of Nuclear Medicine, Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, pad. Granelli, Via F. Sforza, 35, 20122 Milan, Italy
2
Department of Health Sciences, University of Milan, Milan, Italy
3
Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
4
Internal Medicine Department, Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Milan, Italy
values were generally observed when disease relapse or incomplete response to therapy (active disease) occurred, whereas lower uptake was found in studies of remitted patients (p = \0.01), whose FDG levels were similar to those of control subjects. At ROC analysis performed on all image dataset, optimal cut-off levels of regional and global FDG vascular uptake provided a good discrimination between 25 patients at diagnosis and 15 control subjects (aSUV greater than 0.697; PPV = 92.3; NPV = 92.9). Major overlap was observed among FDG levels of 21 patients with active disease and in remission (aSUV greater than 0.653; PPV = 58.3; NPV = 94.1). Similar performances of visual and semiquantitative analyses were found when areas under curves (AUCs) were compared. Conclusions 18F-FDG PET/CT has a promising role in grading inflammation in patients with large arteries vasculitis. Nevertheless, a cut-off based analysis of FDG vascular uptake is not sufficient to separate patients with active and inactive disease during follow-up. Keywords PET/CT Large vessel vasculitis Inflammation SUV analysis
Introduction Gian
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