Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul;50(9):2647-2655.
doi: 10.1007/s00259-023-06220-5. Epub 2023 Apr 28.

Development of a simple standardized scoring system for assessing large vessel vasculitis by 18F-FDG PET-CT and differentiation from atherosclerosis

Y A A Bacour  1 , M P van Kanten  1 , F Smit  2 , E F I Comans  3 , M Akarriou  4 , H C W de Vet  5 , A E Voskuyl  6 , C J van der Laken  6 , Y M Smulders  7
Affiliations

Development of a simple standardized scoring system for assessing large vessel vasculitis by 18F-FDG PET-CT and differentiation from atherosclerosis

Y A A Bacour et al. Eur J Nucl Med Mol Imaging. 2023 Jul.

Abstract

Purpose: This study is to develop a structured approach to distinguishing large-artery vasculitis from atherosclerosis using 18-fluorodeoxyglucose positron emission tomography combined with low-dose computed tomography (FDG PET/CT).

Methods: FDG PET/CT images of 60 patients were evaluated, 30 having biopsy-proven giant cell arteritis (GCA; the most common form of large-artery vasculitis), and 30 with severe atherosclerosis. Images were evaluated by 12 nuclear medicine physicians using 5 criteria: FDG uptake pattern (intensity, distribution, circularity), the degree of calcification, and co-localization of calcifications with FDG-uptake. Criteria that passed agreement, and reliability tests were subsequently analysed for accuracy using receiver operator curve (ROC) analyses. Criteria that showed discriminative ability were then combined in a multi-component scoring system. Both initial and final 'gestalt' conclusion were also reported by observers before and after detailed examination of the images.

Results: Agreement and reliability analyses disqualified 3 of the 5 criteria, leaving only FDG uptake intensity compared to liver uptake and arterial wall calcification for potential use in a scoring system. ROC analysis showed an area under the curve (AUC) of 0.90 (95%CI 0.87-0.92) for FDG uptake intensity. Degree of calcification showed poor discriminative ability on its own (AUC of 0.62; 95%CI 0.58-0.66). When combining presence of calcification with FDG uptake intensity into a 6-tiered scoring system, the AUC remained similar at 0.91 (95%CI 0.88-0.93). After exclusion of cases with arterial prostheses, the AUC increased to 0.93 (95%CI 0.91-0.95). The accuracy of the 'gestalt' conclusion was initially 89% (95%CI 86-91%) and increased to 93% (95%CI 91-95%) after detailed image examination.

Conclusion: Standardised assessment of arterial wall FDG uptake intensity, preferably combined with assessment of arterial calcifications into a scoring method, enables accurate, but not perfect, distinction between large artery vasculitis and atherosclerosis.

Keywords: 18-Fluorodeoxyglucose positron emission tomography; Atherosclerosis; Computed tomography; Diagnosis; Vasculitis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ROC curve of FDG uptake intensity in 3 categories (‘uptake 3’) and calcification. U3 = uptake 3, C = calcification. Followed by cut-off points behind semicolons
Fig. 2
Fig. 2
ROC curve of combined 6-component (C6) and 4-component (C4) criterion. Coordinates of the curve show cut-off values denoted as belonging to C6 or C4
Fig. 3
Fig. 3
ROC curve of 6-component method without prosthesis cases
See this image and copyright information in PMC

References

    1. Lazarewicz K, Watson P. Giant cell arteritis. BMJ. 2019;365:l1964. doi: 10.1136/bmj.l1964. - DOI - PubMed
    1. Davies CG, May DJ. The role of temporal artery biopsies in giant cell arteritis. Ann R Coll Surg Engl. 2011;93:4–5. doi: 10.1308/003588411X12851639107476. - DOI - PMC - PubMed
    1. Ing EB, Wang DN, Kirubarajan A, Benard-Seguin E, Ma J, Farmer JP, Belliveau MJ, Sholohov G, Torun N. Systematic review of the yield of temporal artery biopsy for suspected giant cell arteritis. Neuroophthalmology. 2018;43:18–25. doi: 10.1080/01658107.2018.1474372. - DOI - PMC - PubMed
    1. Hellmich B, Agueda A, Monti S, Buttgereit F, de Boysson H, Brouwer E, Cassie R, Cid MC, Dasgupta B, Dejaco C, Hatemi G, Hollinger N, Mahr A, Mollan SP, Salvarani C, Sivakumar R, Tian X, Tomasson G, Turesson C, Schmidt W, Viliger PM, Watts R, Toung C, Luqmani RA. 2018 update of the EULAR recommendations for the management of large-vessel vasculitis. Ann Rheum Dis. 2020;79:19–30. doi: 10.1136/annrheumdis-2019-215672. - DOI - PubMed
    1. K. Johnsrud, K. Skagen, T. Seierstad, M. Skjelland, D. Russell, M.E. Revheim(18)F-FDG PET/CT for the quantification of inflammation in large carotid artery plaques. J Nucl Cardiol 2019;26:883–893 - PMC - PubMed

MeSH terms

Substances