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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.

Original publication

DOI

10.1007/s00259-011-1967-x

Type

Journal article

Journal

European journal of nuclear medicine and molecular imaging

Publication Date

02/2012

Volume

39

Pages

344 - 353

Addresses

Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031 Basel, Switzerland.

Keywords

Humans, Arteritis, Vasculitis, Fluorodeoxyglucose F18, Immunosuppressive Agents, Radiopharmaceuticals, Positron-Emission Tomography, Regression Analysis, Sensitivity and Specificity, Case-Control Studies, Reproducibility of Results, Predictive Value of Tests, Rheumatology, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Takayasu Arteritis