Walter Martin A, Melzer Ralph A, Schindler Christian, Müller-Brand Jan, Tyndall Alan, Nitzsche Egbert U
Institute of Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
Eur J Nucl Med Mol Imaging. 2005 Jun;32(6):674-81. doi: 10.1007/s00259-004-1757-9. Epub 2005 Mar 4.
This study was performed to investigate the value of( 18)F-fluorodeoxyglucose positron emission tomography ([(18)F]FDG-PET) in the diagnosis of large-vessel vasculitis and the assessment of activity and extent of disease.
Twenty-six consecutive patients (21 females, 5 males; median age - years, range 17-86 years) with giant cell arteritis or Takayasu's arteritis were examined with [(18)F]FDG-PET. Follow-up scans were performed in four patients. Twenty-six age- and gender-matched controls (21 females, 5 males; median age 71 years, range 17-86 years) were included. The severity of large-vessel [(18)F]FDG uptake was visually graded using a four-point scale. C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were measured and correlated with [(18)F]FDG-PET results by logistic regression.
[(18)F]FDG-PET revealed pathological findings in 18 of 26 patients. Three scans were categorised as grade I, 12 as grade II and 3 as grade III arteritis. Visual grade was significantly correlated with both CRP and ESR levels (p=0.002 and 0.007 respectively; grade I: CRP 4.0 mg/l, ESR 6 mm/h; grade II: CRP 37 mg/l, ESR 46 mm/h; grade III: CRP 172 mg/l, ESR 90 mm/h). Overall sensitivity was 60% (95% CI 40.6-77.3%), specificity 99.8% (95% CI 89.1-100%), positive predictive value 99.7% (95% CI 77-100%), negative predictive value 67.9% (95% CI 49.8-80.9%) and accuracy 78.6% (95% CI 65.6-88.4%). In patients presenting with a CRP <12 mg/l or an ESR <12 mm/h, logistic regression revealed a sensitivity of less than 50%. In patients with high CRP/ESR levels, sensitivity was 95.5%/80.7%.
[(18)F]FDG-PET is highly effective in assessing the activity and the extent of large-vessel vasculitis. Visual grading was validated as representing the severity of inflammation. Its use is simple and provides high specificity, while high sensitivity is achieved by scanning in the state of active inflammation.
本研究旨在探讨18F-氟脱氧葡萄糖正电子发射断层扫描（[(18)F]FDG-PET）在大血管血管炎诊断以及疾病活动度和范围评估中的价值。
对26例连续的巨细胞动脉炎或高安动脉炎患者（21例女性，5例男性；中位年龄——岁，范围17 - 86岁）进行[(18)F]FDG-PET检查。4例患者进行了随访扫描。纳入了26例年龄和性别匹配的对照者（21例女性，5例男性；中位年龄71岁，范围17 - 86岁）。使用四点量表对大血管[(18)F]FDG摄取的严重程度进行视觉分级。测量了C反应蛋白（CRP）和红细胞沉降率（ESR），并通过逻辑回归将其与[(18)F]FDG-PET结果进行关联。
[(18)F]FDG-PET在26例患者中的18例显示出病理结果。3次扫描被分类为I级动脉炎，12次为II级，3次为III级。视觉分级与CRP和ESR水平均显著相关（分别为p = 0.002和0.007；I级：CRP 4.0 mg/l，ESR 6 mm/h；II级：CRP 37 mg/l，ESR 46 mm/h；III级：CRP 172 mg/l，ESR 90 mm/h）。总体敏感性为60%（95%CI 40.6 - 77.3%），特异性为99.8%（95%CI 89.1 - 100%），阳性预测值为99.7%（95%CI 77 - 100%），阴性预测值为67.9%（95%CI 49.8 - 80.9%），准确性为78.6%（95%CI 65.6 - 88.4%）。在CRP<12 mg/l或ESR<12 mm/h的患者中，逻辑回归显示敏感性低于50%。在CRP/ESR水平高的患者中，敏感性为95.5%/80.7%。
[(18)F]FDG-PET在评估大血管血管炎的活动度和范围方面非常有效。视觉分级被验证可代表炎症的严重程度。其使用简单且具有高特异性，而在炎症活动状态下进行扫描可实现高敏感性。
