DOI: 10.1007/s00259-017-3774-5Pages: 1-6

Giant-cell arteritis: concordance study between aortic CT angiography and FDG-PET/CT in detection of large-vessel involvement

1. Caen University Hospital, Department of Internal Medicine

2. Limoges University Hospital, Department of Internal Medicine

3. Lille University Hospital, Department of Internal Medicine

4. Caen University Hospital, Department of Nuclear Medicine

5. INSERM U1086 “ANTICIPE”, François Baclesse Cancer Centre

6. Normandy University

Correspondence to:
Hubert de Boysson
Tel: +33 2 31 06 45 79
Email: deboysson-h@chu-caen.fr

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Abstract

Purpose

The purpose of our study was to assess the concordance of aortic CT angiography (CTA) and FDG-PET/CT in the detection of large-vessel involvement at diagnosis in patients with giant-cell arteritis (GCA).

Methods

We created a multicenter cohort of patients with GCA diagnosed between 2010 and 2015, and who underwent both FDG-PET/CT and aortic CTA before or in the first ten days following treatment introduction. Eight vascular segments were studied on each procedure. We calculated concordance between both imaging techniques in a per-patient and a per-segment analysis, using Cohen’s kappa concordance index.

Results

We included 28 patients (21/7 women/men, median age 67 [56–82]). Nineteen patients had large-vessel involvement on PET/CT and 18 of these patients also presented positive findings on CTA. In a per-segment analysis, a median of 5 [1–7] and 3 [1–6] vascular territories were involved on positive PET/CT and CTA, respectively (p = 0.03). In qualitative analysis, i.e., positivity of the procedure suggesting a large-vessel involvement, the concordance rate between both procedures was 0.85 [0.64–1]. In quantitative analysis, i.e., per-segment analysis in both procedures, the global concordance rate was 0.64 [0.54–0.75]. Using FDG-PET/CT as a reference, CTA showed excellent sensitivity (95%) and specificity (100%) in a per-patient analysis. In a per-segment analysis, sensitivity and specificity were 61% and 97.9%, respectively.

Conclusions

CTA and FDG-PET/CT were both able to detect large-vessel involvement in GCA with comparable results in a per-patient analysis. However, PET/CT showed higher performance in a per-segment analysis, especially in the detection of inflammation of the aorta’s branches.

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  • Accepted: Jun 30, 2017
  • Online: Jul 24, 2017

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