18F-FDG PET/CT、头颅MRI、超声及颞动脉活检在巨细胞动脉炎诊断准确性的直接比较
Direct comparison of the diagnostic accuracy of PET/CT, cranial MRI, ultrasound and temporal artery biopsy in giant cell arteritis.
作者信息
Moreel Lien, Betrains Albrecht, Boeckxstaens Lennert, Pieters Griet, Wuyts Els, Weynand Birgit, Fourneau Inge, Van Laere Koen, Demaerel Philippe, De Langhe Ellen, Vanderschueren Steven, Blockmans Daniel
机构信息
Department of General Internal Medicine, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
出版信息
Eur J Nucl Med Mol Imaging. 2025 Feb 26. doi: 10.1007/s00259-025-07166-6.
PURPOSE
To evaluate the diagnostic accuracy of PET/CT, cranial MRI, ultrasound and temporal artery biopsy (TAB) in patients with suspected giant cell arteritis (GCA) in a direct comparison.
METHODS
Consecutive patients with a suspicion of GCA and at least 2 diagnostic tests ≤ 7 days after initiation of glucocorticoids between June 2021 and June 2024, were included retrospectively. The gold standard for the diagnosis of GCA was the judgment of experienced clinicians after a follow-up of ≥ 6 months. Examinations were compared within subgroups undergoing the same tests.
RESULTS
Sixty-one GCA patients and 50 patients with an alternative diagnosis were included. Combined cranial and large vessel PET/CT had the highest sensitivity (89% [95%CI 77-96%]) and specificity (98% [95%CI 88-100%]). Cranial PET/CT and TAB yielded a better sensitivity compared to temporal artery ultrasound (83% [95%CI 64-94%], 77% [95%CI 59-90%] and 55% [95%CI 36-74%], respectively, p = 0.023) without difference in specificity (100% [95%CI 100 - 84%], 95% [95%CI 76-100%] and 81% [95%CI 58-95%], respectively, p = 0.136). Cranial MRI had a sensitivity of 56% (95%CI 21-86%) and specificity of 82% (95%CI 48-98%). Large vessel PET/CT resulted in a better sensitivity compared to axillary artery ultrasound (68% [95%CI 45-86%] vs. 18% [95%CI 5-40%], p = 0.001) without difference in specificity (100% [95% CI 82-100%] vs. 90% [95%CI 67-99%], p = 0.50).
CONCLUSION
PET/CT had a better sensitivity than ultrasound and cranial MRI. TAB and cranial PET/CT had a similar diagnostic yield.
CLINICAL TRIAL NUMBER
Not applicable.
目的
直接比较正电子发射断层扫描/计算机断层扫描（PET/CT）、头颅磁共振成像（MRI）、超声和颞动脉活检（TAB）在疑似巨细胞动脉炎（GCA）患者中的诊断准确性。
方法
回顾性纳入2021年6月至2024年6月期间连续的疑似GCA患者，这些患者在开始使用糖皮质激素后≤7天内接受了至少2项诊断检查。GCA诊断的金标准是经验丰富的临床医生在随访≥6个月后的判断。在接受相同检查的亚组内对各项检查进行比较。
结果
纳入61例GCA患者和50例其他诊断的患者。头颅和大血管联合PET/CT的敏感性最高（89%[95%置信区间77 - 96%]），特异性最高（98%[95%置信区间88 - 100%]）。与颞动脉超声相比，头颅PET/CT和TAB的敏感性更高（分别为83%[95%置信区间64 - 94%]、77%[95%置信区间59 - 90%]和55%[95%置信区间36 - 74%]，p = 0.023），而特异性无差异（分别为100%[95%置信区间100 - 84%]、95%[95%置信区间76 - 100%]和81%[95%置信区间58 - 95%]，p = 0.136）。头颅MRI的敏感性为56%（95%置信区间21 - 86%），特异性为82%（95%置信区间48 - 98%）。与腋动脉超声相比，大血管PET/CT的敏感性更高（68%[95%置信区间45 - 86%]对18%[95%置信区间5 - 40%]，p = 0.001），特异性无差异（100%[95%置信区间82 - 100%]对90%[95%置信区间67 - 99%]，p = 0.50）。
结论
PET/CT的敏感性优于超声和头颅MRI。TAB和头颅PET/CT的诊断率相似。
临床试验编号
不适用。
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