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THU0272 Diagnostic Performance and Disease Activity Assessment by FDG-PET in Large-Vessel Vasculitis: A Systematic Literature Review and Meta-Analysis
  1. M. Soussan1,
  2. P. Nicolas2,
  3. C. Schramm3,
  4. S. Katsahian4,
  5. O. Fain5,6,
  6. A. Mekinian6
  1. 1Nuclear Medicine
  2. 2Pharmacology, Avicenne, Bobigny
  3. 3INSERM, Paris
  4. 4Biostatistics, APHP, HEGP
  5. 5Internal Medicine, Saint Antoine Hospital
  6. 6DHU I2B internal Medicine, CHU Saint Antoine, Paris, France

Abstract

Objectives We aimed to clarify the role of FDG-PET in the management of large-vessel vasculitis, focusing on three issues i) describe and determine the different FDG-PET criteria for the diagnosis of vascular inflammation ii) the performance of FDG-PET for the diagnosis of large-vessel inflammation in GCA patients and iii) the performance of FDG-PET to evaluate the disease inflammatory activity in TA patients.

Methods MEDLINE, Cochrane Library and EMBASE database were searched for articles that evaluated the value of FDG-PET in large-vessel vasculitis, from 01/2000 to 12/2013. Inclusion criteria were: American College of Rheumatology (ACR) criteria for GCA or TA, definition PET positivity threshold, and >4 cases included. Sensitivity (Se) and specificity (Sp) of FDG-PET for the diagnosis of large-vessel inflammation were calculated from each included individual study, and then pooled for meta-analysis with a random effects model.

Results 21 studies (413 patients, 299 controls) were included in the systematic review. FDG-PET showed FDG vascular uptake in 70% (288/413) of patients and 7% (22/299) of controls. Only vascular uptake equal or higher than the liver uptake was significantly different between GCA/TA patients and controls (p<0.001). The meta-analysis of GCA patients (4 studies, 57 patients), shows that FDG-PET has high Se and Sp for the diagnosis of large-vessel inflammation in GCA patients in comparison to controls, with a pooled Se at 90% (95%CI,0.79-0.96) and a pooled Sp at 98% (95% CI,0.94-0.99). The meta-analysis of TA patients (7 studies, 191 patients), shows that FDG-PET has a pooled Se at 87% (95%CI,0.78- 0.93) and Sp at 73% (95%CI,0.63- 0.81) for the assessment of disease activity in TA, with Sp to 84%, with studies using NIH criteria as disease activity assessment scale.

Conclusions FDG-PET showed good performances for the diagnosis of large-vessel inflammation, with higher accuracy in GCA compared to TA patients. A visual analysis of vascular uptake, equal or higher than the liver uptake, appears as the best criteria for the diagnosis of large-vessel vasculitis.

Disclosure of Interest None declared

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