Use of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosing giant cell arteritis in a Western Australian tertiary centre: a 36-month analysis.
Madeleine Venables, Andrew Taylor, Julia Murdoch, Jean-Louis De Sousa, Helen Keen
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引用次数: 0
Abstract
Background: Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has been established as a beneficial diagnostic tool in large vessel vasculitis. There have been limited studies of its use in real-world clinical practice. We examined patients at Royal Perth Hospital (RPH) with suspected giant cell arteritis (GCA) from January 2019 to 2022 who had 18F-FDG-PET/CT, and analysed its diagnostic accuracy compared to temporal artery biopsy (TAB) and clinical diagnosis at 6 months.
Methods: Patients referred to RPH Rheumatology with suspected GCA from January 2019 to 2022 were identified as having had 18F-FDG-PET/CT for diagnostic evaluation. 18F-FDG-PET/CT results were dichotomous into positive (consistent with GCA) or negative, and compared to TAB and clinical diagnosis of GCA at 6 months by a consultant rheumatologist.
Results: A total of 32 patients had 18F-FDG-PET/CT for diagnostic purposes; nine of 32 18F-FDG-PET/CT scans were positive. Compared to TAB, 18F-FDG-PET/CT had a sensitivity of 50%, a specificity of 93%, a positive predictive value (PPV) of 86%, a negative predictive value (NPV) of 68% and accuracy of 61.5%. Compared to clinical diagnosis, 18F-FDG-PET/CT had a sensitivity of 41%, a specificity of 100%, a PPV of 100%, an NPV of 44% and accuracy of 59.4%. Only one 18F-FDG-PET/CT (11%) had cranial artery involvement. The median time taking glucocorticoids (GCs) was 7 days (interquartile range (IQR) 0-22.5 days) for positive 18F-FDG-PET/CT scans, versus 13 days (IQR 8-39 days) for negative 18F-FDG-PET/CT scans. The median time from request to scan was 29 days (IQR 31.5-77 days) for 18F-FDG-PET/CT on 14 or more days of GCs.
Conclusion: 18F-FDG-PET/CT is more likely to be positive if it is performed within 7 days of steroid commencement. 18F-FDG-PET/CT had lower sensitivity and higher specificity than reported in clinical studies. In clinical practice, the significant delays from steroid start to scan time may reduce diagnostic sensitivity. A negative 18F-FDG-PET/CT scan did not negate the need for further investigations.
期刊介绍：
The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.
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