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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Comparative study of 18F-FDG PET/CT and CT angiography in the detection of large...
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Vol. 38. Issue 5.
Pages 280-289 (September - October 2019)
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Vol. 38. Issue 5.
Pages 280-289 (September - October 2019)
Original Article
DOI: 10.1016/j.remnie.2019.06.001
Comparative study of 18F-FDG PET/CT and CT angiography in the detection of large vessel vasculitis
Estudio comparativo de la PET/TC con 18F-FDG y la angiografía por TC en la detección de la vasculitis de grandes vasos
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M. Moragas Solanesa,
Corresponding author
mmoragas@tauli.cat

Corresponding author.
, M. Andreu Magarolasb, J.C. Martín Miramona, A.P. Caresia Arózteguia, M. Monteagudo Jiménezc, J.C. Oliva Morerad, C. Diaz Martína, A. Rodríguez Revueltoa, Z. Bravo Ferrera, Ll. Bernà Roquetaa
a Servicio de Medicina Nuclear, Parc Taulí Hospital Universitario, Sabadell (Barcelona), Spain
b Servicio de Radiología, Parc Taulí Hospital Universitario, Sabadell (Barcelona), Spain
c Servicio de Medicina Interna, Parc Taulí Hospital Universitario, Sabadell (Barcelona), Spain
d Fundación Parc Tauli, Unidad ensayos clínicos, Parc Taulí Hospital Universitario, Sabadell (Barcelona), Spain
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Tables (2)
Table 1. Diagnostic yield of 18F-FDG PET/CT and angioCT in the 59 patients with clinical suspicion of large vessel vasculitis.
Table 2. Comparative analysis of the results of 18F-FDG PET/CT and angioCT by patient and by affected vascular segments in positive 18F-FDG PET/CT and/or angioCT studies.
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Abstract
Objective

Compare 18F-FDG PET/CT and CTangio in the diagnosis of extracraneal large vessel involvement in patients with suspicion of large vessel vasculitis (LVV).

Material and methods

A retrospective database reviewed 59 patients with clinical suspicion of LVV undergoing 18F-FDG PET/CT and CTangio. In 55 patients PET/TC and CTangio were done simultaneously in the same machine and in 4 patients with a scan interval of <1 month. PET/CT analyses included qualitatively and quantitative analysis (ratio SUVmax 118F-FDG vessel/SUVmax liver). CTangio was assessed for concentric mural thickening, contrast wall enhancement and structural vascular changes as potential complications of vasculitis.

Results

18F-FDG PET/CT and CTangio show high specificity (97.2%) for LVV diagnosis, with an excellent sensitivity for 18F-FDG PET/CT (95.6%) and lower for CTangio (60.9%), which leads to a high negative predictive value for 18F-FDG PET/CT (97.2%) and a high false negative rate for CTangio (39.1%). A 70% concordance between 18F-FDG PET/CT and CTangio was obtained (Kappa index 0.70±0.095 (p<.001).

Conclusion

The results show the greater potential of 18F-FDG PET/CT for the detection and extension of LVV. Therefore, 18F-FDG PET/CT should be exploited to the maximum and consider as the first line imaging technique in the extracranial diagnosis of LVV and its possible association with polymyalgia rheumatica. The addition of CTangio could be more indicated in patients with Takayasu arteritis and in long-standing and/or severe vasculitis since it increases the accuracy in the detection of possible vascular complications.

Keywords:
18F-FDG PET/CT
CT angiography
Large vessel vasculitis
Giant cell arteritis
Takayasu arteritis
Resumen
Objetivo

Comparar la PET/TC con 18F-FDG y la angioTC en el diagnóstico de la afectación extracraneal en pacientes con sospecha de vasculitis de grandes vasos (VGV).

Material y método

Estudio retrospectivo en 59 pacientes con sospecha clínica de VGV, estudiados con PET/TC con 18F-FDG y angioTC. En 55 pacientes la PET/TC y angioTC se realizaron simultáneamente en la misma máquina y en 4 pacientes en un interval <1 mes. La PET/TC se valoró cualitativamente y cuantitativamente (cociente SUVmáx 18F-FDG vaso/SUVmáx hígado). En la angioTC se valoró el engrosamiento mural, el realce de contraste en la pared del vaso y las complicaciones vasculares.

Resultados

La PET/TC con 18F-FDG y la angioTC mostraron una elevada especificidad (97.2%) para el diagnóstico de VGV, con una excelente sensibilidad para la PET/TC con 18F-FDG (95.6%) y menor para la angioTC (60.9%), un alto valor predictivo negativo para la PET/TC con 18F-FDG (97.2%) y una alta tasa de falsos negativos para angioTC (39.1%). Se obtuvo una concordancia entre PET/TC con 18F-FDG y angioTC del 70% (índice Kappa 0,70±0,095) (p<0,001).

Conclusión

Los resultados demuestran un mayor potencial de la PET/TC con 18F-FDG para la detección y extensión de la VGV. La PET/TC con 18F-FDG debe considerarse como la exploración de primera línea en el diagnóstico extracraneal de VGV y su posible asociación con la polimialgia reumática. La angioTC podría estar más indicada en pacientes con arteritis de Takayasu y en vasculitis de larga duración y/o severas, al detectar las posibles complicaciones vasculares.

Palabras clave:
PET/TC con 18F-FDG
Angiografía TC
Vasculitis grandes vasos
Arteritis células gigantes
Arteritis de Takayasu

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