Departments of Rheumatology, Nuclear Medicine and Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Northern and Central Clinical Schools, University of Sydney, Sydney, New South Wales, Australia.
Int J Rheum Dis. 2020 Apr;23(4):582-588. doi: 10.1111/1756-185X.13805. Epub 2020 Feb 26.
Positron emission tomography/computed tomography (PET/CT) can detect cranial and large vessel inflammation in giant cell arteritis (GCA). We aimed to determine the change and significance of vascular activity at diagnosis and 6 months.
Newly diagnosed GCA patients underwent time-of-flight fluorine-18-fluoro-2-deoxyglucose PET/CT from vertex to diaphragm within 72 hours of commencing corticosteroids and were followed for 12 months. A 6 months scan was performed in patients with inflammatory features on biopsy or CT aortitis. Vascular uptake was visually graded by 2 blinded readers across 18 artery segments from 0 (no increased uptake) to 3 (very marked uptake). Scores were summed to give a total vascular score (TVS).
We enrolled 21 GCA patients and 15 underwent the serial scan. Twelve (57%) patients experienced a relapse and 5 of these had ischemic features of vision disturbance, jaw or limb claudication. The median TVS fell from 14 (interquartile range [IQR] 4-24) at baseline to 5 (IQR 0-10) at 6 months (P < .01) with reduction in both cranial and large artery scores. While the overall relapse rate was similar between patients with a high (≥10) and low baseline TVS, patients with high scores were numerically more likely to experience an ischemic relapse (33% vs 11%, P = .34). Five out of 15 patients had persistent uptake in at least 1 vessel on the serial PET/CT but none experienced a subsequent relapse.
Vascular activity decreased in cranial and large arteries between diagnosis and 6 months. Persistent activity did not predict subsequent relapse.
正电子发射断层扫描/计算机断层扫描（PET/CT）可检测巨细胞动脉炎（GCA）中的颅内外血管炎症。本研究旨在确定诊断时和 6 个月时血管活性的变化及意义。
新诊断的 GCA 患者在开始皮质类固醇治疗的 72 小时内接受氟-18-氟代-2-脱氧葡萄糖时间飞行 PET/CT 扫描，扫描范围从头顶至膈肌，并随访 12 个月。在活检或 CT 主动脉炎有炎症特征的患者中进行 6 个月扫描。2 位盲法阅片者对 18 个动脉节段（0 分为无摄取增加，3 分为明显摄取增加）进行血管摄取的视觉评分，评分相加得出总血管评分（TVS）。
共纳入 21 例 GCA 患者，其中 15 例完成了系列扫描。12 例（57%）患者复发，其中 5 例有视力障碍、咀嚼或肢体跛行的缺血表现。TVS 中位数从基线时的 14 分（四分位距[IQR] 4-24）降至 6 个月时的 5 分（IQR 0-10，P <.01），颅内外动脉评分均降低。虽然基线 TVS 较高（≥10）和较低的患者复发率相似，但高评分患者发生缺血性复发的可能性略高（33% vs 11%，P =.34）。15 例患者中有 5 例在连续 PET/CT 上至少有 1 个血管存在持续性摄取，但均未发生后续复发。
诊断时和 6 个月时颅内外动脉的血管活性降低。持续性活性不能预测后续复发。
