Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031 Basel, Switzerland.
Eur J Nucl Med Mol Imaging. 2012 Feb;39(2):344-53. doi: 10.1007/s00259-011-1967-x. Epub 2011 Nov 10.
We aimed to assess the impact of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the management of patients with suspected large vessel vasculitis.
An international expert panel determined diagnoses and clinical management in patients with suspected large vessel vasculitis, with and without the results of (18)F-FDG PET, respectively. The accuracy of the clinical diagnosis and the resulting clinical management with and without the (18)F-FDG PET results were compared using logistic regression models.
The analysis included 30 patients referred to a tertiary care centre with large vessel vasculitis and 31 controls. (18)F-FDG PET had an overall sensitivity of 73.3% [95% confidence interval (CI) 54.1-87.7%], a specificity of 83.9% (95% CI 66.3-94.5%), a positive predictive value of 81.5% (95% CI 61.9-93.7%) and a negative predictive value of 76.5% (95% CI 58.8-89.3%). The diagnostic accuracy of (18)F-FDG PET was higher in patients not receiving immunosuppressive drugs (93.3 vs 64.5%, p = 0.006). Taken in context with other available diagnostic modalities, the addition of (18)F-FDG PET increased the clinical diagnostic accuracy from 54.1 to 70.5% (p = 0.04). The addition of (18)F-FDG PET increased the number of indicated biopsies from 22 of 61 patients (36.1%) to 25 of 61 patients (41.0%) and changed the treatment recommendation in 8 of 30 patients (26.7%) not receiving immunosuppressive medication and in 7 of 31 patients (22.6%) receiving immunosuppressive medication.
(18)F-FDG PET is a sensitive and specific imaging tool for large vessel vasculitis, especially when performed in patients not receiving immunosuppressive drugs. It increases the overall diagnostic accuracy and has an impact on the clinical management in a significant proportion of patients.
评估 18 氟-氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）对疑似大血管血管炎患者治疗的影响。
国际专家小组分别确定了疑似大血管血管炎患者的诊断和临床治疗，以及是否有 18F-FDG PET 的结果。使用逻辑回归模型比较了临床诊断的准确性以及是否有 18F-FDG PET 结果的临床管理。
该分析包括 30 名因大血管血管炎而被转诊至三级护理中心的患者和 31 名对照者。18F-FDG PET 的总体敏感性为 73.3%（95%置信区间[CI]为 54.1-87.7%），特异性为 83.9%（95%CI 为 66.3-94.5%），阳性预测值为 81.5%（95%CI 为 61.9-93.7%），阴性预测值为 76.5%（95%CI 为 58.8-89.3%）。未接受免疫抑制剂治疗的患者中，18F-FDG PET 的诊断准确性更高（93.3% vs 64.5%，p=0.006）。结合其他可用的诊断方法，18F-FDG PET 的加入使临床诊断准确性从 54.1%提高到 70.5%（p=0.04）。18F-FDG PET 的加入使需要活检的患者数量从 61 名患者中的 22 名（36.1%）增加到 61 名患者中的 25 名（41.0%），并使 30 名未接受免疫抑制剂治疗的患者中的 8 名（26.7%）和 31 名接受免疫抑制剂治疗的患者中的 7 名（22.6%）的治疗建议发生改变。
18F-FDG PET 是一种敏感和特异的大血管血管炎成像工具，特别是在未接受免疫抑制剂治疗的患者中。它提高了整体诊断准确性，并对很大一部分患者的临床管理产生了影响。
