The utility of 18F-FDG-PET/CT in detecting extracranial large vessel vasculitis in rheumatic polymyalgia or giant cell arteritis. A systematic review and meta-analysis

Objective

Systematic review of current evidence to analyze the prevalence of extracranial large vessel vasculitis (LVV) using ¹⁸F-FDG PET/CT in patients with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA).

Materials and methods

PubMed and EMBASE were searched and the results were screened by two reviewers. Study quality was assessed using a modified version of the Newcastle-Ottawa scale. Heterogeneity between studies was assessed using the I² statistic and the Q test. Further subgroup analyses were performed by disease type, study quality, and ¹⁸F-FDG PET/CT uptake criteria. Publication bias was assessed by funnel plot and Egger's test.

Results

268 publications were identified, of which 17 met the selection criteria and were included in the meta-analysis. The overall pooled prevalence of extracranial LVV by ¹⁸F-FDG PET/CT was 54.5% [95% CI: 42.6%–66.1%]. In patients with GCA the prevalence was significantly higher than in patients with PMR (60.1% vs. 41.8%, P = 0.006). Likewise, studies with a lower risk of bias reported a higher prevalence of extracranial LVV (61.1% vs. 46.9%; P = 0.010). No publication bias was observed.

Conclusions

The ¹⁸F-FDG PET/CT test may be useful in the detection of extracranial LVV, both in patients with PMR or GCA. Such involvement is more frequent in patients with GCA, and may vary depending on the quality of the studies.