Division of Rheumatology, MedStar Georgetown University Hospital, Washington DC, USA; Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, 10 Center Drive, Building 10, 10N Rm 311D, Bethesda, MD 20892, USA.
Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, 10 Center Drive, Building 10, 10N Rm 311D, Bethesda, MD 20892, USA.
Semin Arthritis Rheum. 2020 Feb;50(1):71-76. doi: 10.1016/j.semarthrit.2019.07.008. Epub 2019 Jul 24.
To determine the impact of imaging acquisition time on interpretation of disease activity on F-fluorodeoxyglucose positron emission tomography (PET) in large-vessel vasculitis (LVV) and assess the relationship between clinical features and image acquisition time.
Patients with giant cell arteritis (GCA) and Takayasu's arteritis (TAK) were recruited into a prospective, observational cohort. After a single injection of FDG, all patients underwent two sequential PET scans at one and two-hour time points. Images were interpreted for active vasculitis by subjective assessment, qualitative assessment, and semi-quantitative assessment. Agreement was assessed by percent agreement, Cohen's kappa, and McNemar's test. Multivariable logistic regression identified associations between PET activity and clinical variables.
79 patients (GCA = 44, TAK = 35) contributed 168 paired one and two-hour PET studies. A total of 94 out of 168 scans (56%) were interpreted as active at the one-hour time point, and 129 scans (77%) were interpreted as active at the two-hour time point (p < 0.01). Associations between clinical variables and PET activity categories (dual inactive, delayed active, dual active) were evaluated. Using multivariable nominal regression, clinically active disease was significantly more common in patients in the delayed active group (Odds Ratio 1.94, 95%CI 1.13-3.53; p = 0.02) and the dual active group (Odds Ratio 1.71, 95%CI 1.06-2.93; p = 0.04) compared to the dual inactive group.
Imaging protocol significantly influences interpretation of PET activity in LVV. A substantial proportion of patients with LVV have PET activity only detected by delayed imaging. These patients were significantly more likely to have concomitant clinically-determined active disease.
确定影像学采集时间对大血管血管炎（LVV）中 F-氟脱氧葡萄糖正电子发射断层扫描（PET）疾病活动度解读的影响，并评估临床特征与影像采集时间之间的关系。
本前瞻性观察性队列研究纳入了巨细胞动脉炎（GCA）和 Takayasu 动脉炎（TAK）患者。所有患者在单次注射 FDG 后，在 1 小时和 2 小时时间点进行两次连续 PET 扫描。通过主观评估、定性评估和半定量评估来判断图像是否存在活动性血管炎。通过百分比一致性、Cohen's kappa 和 McNemar 检验评估一致性。多变量逻辑回归确定了 PET 活性与临床变量之间的关联。
79 例患者（GCA = 44 例，TAK = 35 例）共提供了 168 对 1 小时和 2 小时 PET 研究。共有 94 次（56%）1 小时扫描和 129 次（77%）2 小时扫描被判断为活性（p<0.01）。评估了临床变量与 PET 活性分类（双阴性、延迟性阳性、双阳性）之间的关系。使用多变量名义回归，在延迟性阳性组（优势比 1.94，95%置信区间 1.13-3.53；p=0.02）和双阳性组（优势比 1.71，95%置信区间 1.06-2.93；p=0.04）中，与双阴性组相比，临床活动疾病更为常见。
成像方案显著影响 LVV 中 PET 活性的解读。相当一部分 LVV 患者仅通过延迟成像才能检测到 PET 活性。这些患者更有可能伴有临床上确定的活动性疾病。
