Diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a systematic review and meta-analysis

• Published in: European journal of nuclear medicine and molecular imaging Vol. 38; no. 9; pp. 1764 - 1772
• Main Authors: Besson, Florent L., Parienti, Jean-Jacques, Bienvenu, Boris, Prior, John O., Costo, Sylvie, Bouvard, Gerard, Agostini, Denis
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-09-2011
• Subjects: Cardiology; Fluorodeoxyglucose F18; Giant Cell Arteritis - complications; Giant Cell Arteritis - diagnostic imaging; Humans; Imaging; Medicine; Medicine & Public Health; Nuclear Medicine; Oncology; Orthopedics; Polymyalgia Rheumatica - complications; Positron-Emission Tomography - methods; Radiology; Review Article; Giant cell arteritis; F-FDG; Polymyalgia rheumatica; PET
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-011-1830-0

Purpose
The aim of this study was to conduct a systematic review and perform a meta-analysis on the diagnostic performances of
18
F-fluorodeoxyglucose positron emission tomography (FDG PET) for giant cell arteritis (GCA), with or without polymyalgia rheumatica (PMR).
Methods
MEDLINE, Embase and the Cochrane Library were searched for articles in English that evaluated FDG PET in GCA or PMR. All complete studies were reviewed and qualitatively analysed. Studies that fulfilled the three following criteria were included in a meta-analysis: (1) FDG PET used as a diagnostic tool for GCA and PMR; (2) American College of Rheumatology and Healey criteria used as the reference standard for the diagnosis of GCA and PMR, respectively; and (3) the use of a control group.
Results
We found 14 complete articles. A smooth linear or long segmental pattern of FDG uptake in the aorta and its main branches seems to be a characteristic pattern of GCA. Vessel uptake that was superior to liver uptake was considered an efficient marker for vasculitis. The meta-analysis of six selected studies (101 vasculitis and 182 controls) provided the following results: sensitivity 0.80 [95% confidence interval (CI) 0.63–0.91], specificity 0.89 (95% CI 0.78–0.94), positive predictive value 0.85 (95% CI 0.62–0.95), negative predictive value 0.88 (95% CI 0.72–0.95), positive likelihood ratio 6.73 (95% CI 3.55–12.77), negative likelihood ratio 0.25 (95% CI 0.13–0.46) and accuracy 0.84 (95% CI 0.76–0.90).
Conclusion
We found overall valuable diagnostic performances for FDG PET against reference criteria. Standardized FDG uptake criteria are needed to optimize these diagnostic performances.