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. 2015:2015:914692.
doi: 10.1155/2015/914692. Epub 2015 Jan 28.

Large-vessel vasculitis: interobserver agreement and diagnostic accuracy of 18F-FDG-PET/CT

K D F Lensen  1 , E F I Comans  2 , A E Voskuyl  3 , C J van der Laken  3 , E Brouwer  4 , A T Zwijnenburg  5 , L M Pereira Arias-Bouda  6 , A W J M Glaudemans  7 , R H J A Slart  7 , Y M Smulders  1
Affiliations

Large-vessel vasculitis: interobserver agreement and diagnostic accuracy of 18F-FDG-PET/CT

K D F Lensen et al. Biomed Res Int. 2015.

Abstract

Introduction: (18)F-FDG-PET visualises inflammation. Both atherosclerosis and giant cell arteritis cause vascular inflammation, but distinguishing the two may be difficult. The goal of this study was to assess interobserver agreement and diagnostic accuracy of (18)F-FDG-PET for the detection of large artery involvement in giant cell arteritis (GCA).

Methods: 31 (18)F-FDG-PET/CT scans were selected from 2 databases. Four observers assessed vascular wall (18)F-FDG uptake, initially without and subsequently with predefined observer criteria (i.e., vascular wall (18)F-FDG uptake compared to liver or femoral artery (18)F-FDG uptake). External validation was performed by two additional observers. Sensitivity and specificity of (18)F-FDG-PET were determined by comparing scan results to a consensus diagnosis.

Results: The highest interobserver agreement (kappa: 0.96 in initial study and 0.79 in external validation) was observed when vascular wall (18)F-FDG uptake higher than liver uptake was used as a diagnostic criterion, although agreement was also good without predefined criteria (kappa: 0.68 and 0.85). Sensitivity and specificity were comparable for these methods. The criterion of vascular wall (18)F-FDG uptake equal to liver (18)F-FDG uptake had low specificity.

Conclusion: Standardization of image assessment for vascular wall (18)F-FDG uptake promotes observer agreement, enables comparative studies, and does not appear to result in loss of diagnostic accuracy compared to nonstandardized assessment.

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Figures

Figure 1
Figure 1
18F-FDG PET/CT scans showing: (a) Maximum intensity projection (MIP) image: scored as large-vessel vasculitis by all observers according to all methods, (b) coronal image: 18F-FDG uptake in descending aorta (arrow) scored as equal to liver uptake (arrowhead) by 2 observers and lower than liver uptake by 2 other observers, none of the observers scored higher than liver or femoral artery uptake, (c) MIP image of a PMR patient that was scored negative for large-vessel vasculitis by all observers. (Cerebral and urinary tract 18-18F-FDG uptake are physiological).
See this image and copyright information in PMC

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