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Repetitive 18F-FDG-PET/CT in patients with large-vessel giant-cell arteritis and controlled disease

Published:August 30, 2017DOI:https://doi.org/10.1016/j.ejim.2017.08.013

      Highlights

      • Evolution under treatment of large-vessel uptakes on repetitive PET/CT is unknown.
      • <20% of patients had total extinction of vascular uptakes under treatment.
      • PET/CT results did not influence therapeutic management in controlled disease.

      Abstract

      Objective

      18F-FDG PET/CT can detect large-vessel involvement in giant-cell arteritis (GCA) with a good sensitivity. In patients with clinically and biologically controlled disease, we aimed to assess how vascular uptakes evolve on repetitive FDG-PET/CT.

      Patients and methods

      All included patients had to satisfy the 4 following criteria: 1) diagnosis of GCA was retained according to the criteria of the American College of Rheumatology or based on the satisfaction of 2 criteria associated with the demonstration of large-vessel involvement on FDG-PET/CT; 2) all patients had a positive PET/CT that was performed at diagnosis before treatment or within the first 10 days of treatment; 3) another FDG-PET/CT was performed after at least 3 months of controlled disease without any relapse; 4) patients were followed-up at least for 12 months.

      Results

      Twenty-five patients (17 [68%] women, median age: 69 [65–78]) with large-vessel inflammation on a baseline FDG-PET/CT and with repetitive imaging during the period with controlled disease were included and followed-up for 62 [25–95] months. Four repeated procedures revealed total extinction of vascular uptakes at 11.5 [8–12] months after the first FDG-PET/CT. Eight PET/CT revealed decreased numbers of vascular uptakes, and 10 procedures revealed no changes. The 3 remaining procedures indicated worsening of the numbers of vascular uptakes in the absence of relapse.

      Conclusions

      Our study revealed long-term persistent vascular uptake on repeated FDG-PET/CT in >80% of our GCA patients with large-vessel inflammation and clinical-biological controlled disease. Prospective studies are required to confirm these findings.

      Abbreviations:

      CRP (C-reactive protein), DMARDs (disease-modifying antirheumatic drugs), FDG-PET/CT (positron emission tomography with 18F-fluorodeoxyglucose (FDG) combined with computed tomography (PET/CT)), GC (glucocorticoids), GCA (giant-cell arteritis), TAB (temporal artery biopsy)

      Keywords

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