Department of Nuclear Medicine, CHU Caen, Université Caen Basse-Normandie, Caen, France.
Eur J Nucl Med Mol Imaging. 2011 Sep;38(9):1764-72. doi: 10.1007/s00259-011-1830-0. Epub 2011 May 11.
The aim of this study was to conduct a systematic review and perform a meta-analysis on the diagnostic performances of (18)F-fluorodeoxyglucose positron emission tomography (FDG PET) for giant cell arteritis (GCA), with or without polymyalgia rheumatica (PMR).
MEDLINE, Embase and the Cochrane Library were searched for articles in English that evaluated FDG PET in GCA or PMR. All complete studies were reviewed and qualitatively analysed. Studies that fulfilled the three following criteria were included in a meta-analysis: (1) FDG PET used as a diagnostic tool for GCA and PMR; (2) American College of Rheumatology and Healey criteria used as the reference standard for the diagnosis of GCA and PMR, respectively; and (3) the use of a control group.
We found 14 complete articles. A smooth linear or long segmental pattern of FDG uptake in the aorta and its main branches seems to be a characteristic pattern of GCA. Vessel uptake that was superior to liver uptake was considered an efficient marker for vasculitis. The meta-analysis of six selected studies (101 vasculitis and 182 controls) provided the following results: sensitivity 0.80 [95% confidence interval (CI) 0.63-0.91], specificity 0.89 (95% CI 0.78-0.94), positive predictive value 0.85 (95% CI 0.62-0.95), negative predictive value 0.88 (95% CI 0.72-0.95), positive likelihood ratio 6.73 (95% CI 3.55-12.77), negative likelihood ratio 0.25 (95% CI 0.13-0.46) and accuracy 0.84 (95% CI 0.76-0.90).
We found overall valuable diagnostic performances for FDG PET against reference criteria. Standardized FDG uptake criteria are needed to optimize these diagnostic performances.
本研究旨在对（18）F-氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）在巨细胞动脉炎（GCA）中的诊断性能进行系统评价和荟萃分析，无论是否合并多发性肌痛（PMR）。
在 MEDLINE、Embase 和 Cochrane 图书馆中检索了评估 FDG PET 在 GCA 或 PMR 中的应用的英文文章。对所有完整的研究进行了综述和定性分析。只有满足以下三个标准的研究才被纳入荟萃分析：（1）FDG PET 作为 GCA 和 PMR 的诊断工具；（2）美国风湿病学会（ACR）和 Healey 标准分别作为 GCA 和 PMR 的诊断标准；（3）使用对照组。
我们共找到了 14 篇完整的文章。FDG 在主动脉及其主要分支中的摄取呈光滑的线性或长节段性模式，这似乎是 GCA 的一个特征性模式。与肝脏摄取相比，血管摄取更高被认为是血管炎的有效标志物。对 6 项选定研究（101 例血管炎和 182 例对照）的荟萃分析结果如下：敏感性 0.80（95%置信区间（CI）0.63-0.91），特异性 0.89（95%CI 0.78-0.94），阳性预测值 0.85（95%CI 0.62-0.95），阴性预测值 0.88（95%CI 0.72-0.95），阳性似然比 6.73（95%CI 3.55-12.77），阴性似然比 0.25（95%CI 0.13-0.46），准确度 0.84（95%CI 0.76-0.90）。
我们发现 FDG PET 与参考标准相比具有总体有价值的诊断性能。需要标准化的 FDG 摄取标准来优化这些诊断性能。
