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OP0001 [18F]Fdg PET in Giant-Cell Arteritis: A Prognostic Tool for Aortic Complications
  1. H. de Boysson1,
  2. E. Liozon2,
  3. M. Lambert3,
  4. J.-J. Parienti4,
  5. J. Boutemy1,
  6. K. Ly2,
  7. P.-Y. Hatron3,
  8. A. Manrique5,
  9. B. Bienvenu1
  1. 1Internal Medicine, Centre Hospitalier et Universitaire Côte de Nacre, Caen
  2. 2Internal Medicine, Centre Hospitalier et Universitaire, Limoges
  3. 3Internal Medicine, Centre Hospitalier et Universitaire, Lille
  4. 4Biostatistics and Clinical Research Unit
  5. 5Department of Nuclear Medicine, Centre Hospitalier et Universitaire Côte de Nacre, Caen, France

Abstract

Background Extracranial involvement of large vessels in giant-cell arteritis (GCA) is probably underdiagnosed. Aortic complications (dilatation and dissection) are a prominent cause of death. [18]F-fluorodeoxyglucose positron-emission tomography ([18F]FDG-PET) is an imaging tool that can demonstrate the inflammation of large vessels.

Objectives To assess the value of PET in the diagnosis, the extent of disease's activity and the follow-up of patients with GCA.

Methods Patients were enrolled if they satisfied two criteria: (1) diagnosis of GCA was established fulfilling the American College of Rheumatology criteria (including patients with two criteria and extra-temporal biopsy-proven giant-cell vasculitis); and (2) at least one PET had been performed, at diagnosis (before or in the first 10 days of corticosteroid treatment) or during the follow-up.

Patients' charts were retrospectively reviewed. Clinical symptoms were divided into cephalic and extra-cephalic manifestations. Positivity of PET was defined as a FDG vascular uptake superior to the liver on at least one of the eight following vascular segments: thoracic, abdominal aorta, subclavian, axillary, carotidian, iliac/femoral, and upper and lower limb arteries. Isolated uptakes from the iliac/femoral arteries were not considered as a positive PET.

Results 133 patients were enrolled (88 women [66%], median age 70 [50–86]). GCA was biopsy-proven in 78 patients (59%), including 14 positive temporal-artery biopsies (TAB) in patients without any cephalic symptoms. PET was performed at diagnosis in 67 patients and during the follow-up in 66 patients. PET results were positive in 68 (51%) patients and a median of 4 [1–8] vascular areas were involved. The thoracic aorta was involved in 79% of cases. Patients with a positive PET had significantly more extra-cephalic manifestations (59% vs. 37%, p=0.001) and less cephalic symptoms (71% vs. 94%, p=0.0005) than patients with a negative PET. No difference was noted between the 2 groups regarding the TAB status, inflammatory parameters, or cardiovascular risk factors. With a median follow-up of 35 months [6–263], 76 (57%) patients relapsed, and PET results were not clinically useful in 24/26 patients in whom another PET was performed. Aortic dilatation occurred in 14 (11%) patients (of which, 11 [16%] had a positive PET, p=0.03) and aortic dissection in three patients with a positive PET (all with a known dilatation). In univariable analyses, occurrence of aortic complications was associated with the positivity of PET and the absence of cephalic manifestations (hazards ratio (HR) 3.96 [95% confidence interval 1.1–14.26] and 0.27 [95% CI 0.09–0.85]).

Conclusions To the best of our knowledge, this is the most extensive study on the use of PET in GCA. Half of the assessed patients had an extra-cephalic involvement of GCA. Large-vessel involvement demonstrated on a PET is associated with a higher risk of aortic complications.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.1985

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