Lee Sang-Woo, Kim Seong-Jang, Seo Youngduk, Jeong Shin Young, Ahn Byeong-Cheol, Lee Jaetae
Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Taegu, South Korea.
Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, South Korea.
J Nucl Cardiol. 2019 Feb;26(1):59-67. doi: 10.1007/s12350-018-1406-5. Epub 2018 Aug 17.
The aim of this study is to investigate the performance of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) or positron emission tomography/computed tomography (PET/CT) for the assessment of disease activity in patients with large vessel vasculitis (LVV) through a meta-analysis.
The MEDLINE via PubMed and EMBASE were searched for the studies evaluating the performance of F-18 FDG PET or PET/CT in the assessment of disease activity in patients with LVV. Pooled sensitivity, specificity, diagnostic odds ratios (DORs), and summary receiver-operating characteristic (sROC) curve were estimated across the included studies. Possible publication bias was assessed by Deek's funnel plot asymmetry tests.
A total of 439 PET images from 298 patients pooled from nine studies showed that the pooled sensitivity was 0.88 [95% confidence interval (CI) 0.79-0.93] without heterogeneity (χ = 14.42, P = .07) and the pooled specificity was 0.81 (95% CI 0.64-0.91) with heterogeneity (χ = 63.72, P = .00) for the detection of active LVV. The pooled DOR was 30 (95% CI 8-107). Hierarchical sROC curve indicates that the area under the curve was 0.91 (95% CI 0.89-0.94). There was no significant publication bias (P = .42), and meta-regression analysis revealed that none of the variables was the source of the study heterogeneity.
F-18 FDG PET has a good performance for the detection of active disease status in patients with LVV. Revised criteria for the assessment of disease activity incorporated with F-18 FDG PET or PET/CT should be introduced and validated. Further studies are warranted to determine if PET-based treatment of LVV can improve outcomes.
本研究旨在通过荟萃分析，探讨F-18氟脱氧葡萄糖正电子发射断层扫描（F-18 FDG PET）或正电子发射断层扫描/计算机断层扫描（PET/CT）在评估大血管血管炎（LVV）患者疾病活动度方面的表现。
通过PubMed检索MEDLINE以及EMBASE，查找评估F-18 FDG PET或PET/CT在评估LVV患者疾病活动度方面表现的研究。对纳入研究的合并敏感度、特异度、诊断比值比（DOR）以及汇总的受试者工作特征（sROC）曲线进行估计。通过Deek漏斗图不对称性检验评估可能存在的发表偏倚。
来自9项研究的298例患者的439张PET图像显示，检测活动性LVV时，合并敏感度为0.88[95%置信区间（CI）0.79 - 0.93]，无异质性（χ = 14.42，P = 0.07），合并特异度为0.81（95% CI 0.64 - 0.91），存在异质性（χ = 63.72，P = 0.00）。合并DOR为30（95% CI 8 - 107）。分层sROC曲线表明曲线下面积为0.91（95% CI 0.89 - 0.94）。无显著发表偏倚（P = 0.42），荟萃回归分析显示，没有变量是研究异质性的来源。
F-18 FDG PET在检测LVV患者的活动性疾病状态方面表现良好。应引入并验证结合F-18 FDG PET或PET/CT的疾病活动度评估修订标准。有必要进行进一步研究以确定基于PET的LVV治疗是否能改善预后。
