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Simple dichotomous assessment of cranial artery inflammation by conventional 18F-FDG PET/CT shows high accuracy for the diagnosis of giant cell arteritis: a case-control study

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Abstract

Purpose

To estimate the diagnostic accuracy of conventional 18F-FDG PET/CT of cranial arteries in the diagnosis of giant cell arteritis (GCA).

Methods

The study was a retrospective case-control study. The reference diagnosis was fulfillment of the 1990 ACR criteria for GCA. All patients had new-onset GCA. Conventional 18F-FDG PET/CT was performed before glucocorticoid treatment. Controls were age- and sex-matched patients with a previous history of malignant melanoma (MM) undergoing surveillance PET/CT >6 months after MM resection. PET images were evenly cropped to include only head and neck and were assessed in random order by four nuclear medicine physicians blinded to reference diagnosis. Temporal (TA), maxillary (MA) and vertebral (VA) arteries were visually rated for 18F-FDG uptake. Interreader agreement was evaluated by Fleiss kappa.

Results

A total of 44 patients and 44 controls were identified. In both groups, the mean age was 69 years (p = 0.45) and 25/44 were women. 35/41 GCA patients were temporal artery biopsy positive (TAB). Considering only FDG uptake in TA and/or MA, diagnostic sensitivity and specificity was 64 and 100%. Including VA, sensitivity increased to 82% and specificity remained 100%. Interreader agreement was 91% and Fleiss kappa 0.82 for the PET diagnosis based on the cranial arteries.

Conclusion

Conventional 18F-FDG PET/CT is an accurate and reliable tool to diagnose cranial arteritis in glucocorticoid-naïve GCA patients. The high diagnostic specificity suggests that TAB can be omitted in patients with 18F-FDG uptake in cranial arteries. 18F-FDG PET/CT performed in patients with suspected vasculitis should always include the head and neck.

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Acknowledgements

This work was funded by The Danish Rheumatism Association, Aarhus University, Aarhus University Hospital, Brødrene Hartmann Fond, A.P. Moeller Foundation, and Aase & Ejnar Danielsen Foundation.

We would like to thank Irene Dalsgaard Nielsen, medical secretary, Department of Plastic and Breast surgery, Aarhus University Hospital for assisting the assessment of eligibility of the controls and Anne-Birgitte Blavnsfeldt, MD, Department of Rheumatology, Aarhus University Hospital for editing the manuscript.

Funding

This study was funded by The Danish Rheumatism Association, Aarhus University, Aarhus University Hospital, Brødrene Hartmann Foundation, A.P. Moeller Foundation, Aase & Ejnar Danielsen Foundation.

Author information

Authors and Affiliations

  1. Department of Rheumatology, Aarhus University Hospital, Nørrebrogade 44, bygning 3, 8000, Aarhus, Denmark

    Berit Dalsgaard Nielsen, Ib Tønder Hansen, Kresten Krarup Keller, Philip Therkildsen & Ellen-Margrethe Hauge

  2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Berit Dalsgaard Nielsen, Ib Tønder Hansen, Philip Therkildsen & Ellen-Margrethe Hauge

  3. Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark

    Stine Kramer, Ate Haraldsen, Karin Hjorthaug, Trond Velde Bogsrud & Lars Christian Gormsen

  4. Department of Nuclear Medicine, The Regional Hospital West Jutland, Herning, Denmark

    June Anita Ejlersen

  5. Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark

    Lars Bjørn Stolle

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  1. Berit Dalsgaard Nielsen
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Corresponding author

Correspondence to Berit Dalsgaard Nielsen.

Ethics declarations

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the National Committee on Health Research Ethics and with the 1964 Helsinki Declaration and its later amendments.

The Central Denmark Region Committees on Health Research Ethics (reference number 1–10–72-246-16 and 1–10–72-60-14) and The Danish Data Protection Agency (reference number 1–16–02-380-14 and 1–16–02-481-16) approved the study.

Informed consent

Ethical approval was given to assess 18F-FDG PET/CT of controls and to check prior and current diagnoses in their electronic medical record without informed consent from the patient. All GCA patients gave written, informed consent.

Conflicts of interests

Berit Dalsgaard Nielsen has received fees for speaking from Roche. Ellen-Margrethe Hauge has received fees for speaking from MSD, AbbVie, UCB and Sobi; and received research funding to Aarhus University Hospital from Roche and Novartis. Kresten Krarup Keller has received fees for speaking from Pfizer.

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The views expressed in the submitted article are the authors’ own and not an official position of the institution or funder.

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Nielsen, B.D., Hansen, I.T., Kramer, S. et al. Simple dichotomous assessment of cranial artery inflammation by conventional 18F-FDG PET/CT shows high accuracy for the diagnosis of giant cell arteritis: a case-control study. Eur J Nucl Med Mol Imaging 46, 184–193 (2019). https://doi.org/10.1007/s00259-018-4106-0

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