Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
The Value of Positron Emission Tomography Computed tomography in Patients with Large Vessel Vasculitis.
Tang, Man Wai, Gerlag, Danielle Marie, Hak, A. Elisabeth, van Eck-Smit, Berthe L.F., Tak, Paul-Peter
Positron emission tomography - computed tomography (PET-CT) scan has become a promising, noninvasive diagnostic test in various diseases, such as large vessel vasculitis. It is currently unknown what the influence of corticosteroids on the outcome of this technique is in this disease. The purpose of this research is to study the correlation between the inflammatory markers, erythrocyte sedimentation rate and C-reactive protein (respectively ESR and CRP) and outcome of PET-CT. Furthermore, the influence of corticosteroids on the outcome of PET-CT in large vessel vasculitis will be studied.
24 patients with a suspicion of large vessel vasculitis were evaluated between November 2007 January 2010 using PET-CT. Levels of ESR and CRP were measured and correlated to vascular FDG-uptake. The levels of ESR and CRP were categorized in both normal values, elevated ESR or CRP and both elevated levels. The use of corticosteroids at the time the PET-CT was performed, was also evaluated. Clinical outcome was also studied, which was defined as starting with corticosteroids in patients with and with no pathological vascular FDG-uptake.
Patients with the suspicion of vasculitis who showed pathological vascular FDG-uptake in the large vessels on PET-CT had a higher level of ESR compared to patients without vascular FDG-uptake, respecitively mean ± SD: 72 ± 45 versus 30 ± 20 mm/hr (p=0,011). Similar results were found for the CRP levels with positive and negative FDG-uptake, respectively median 43 (4,2220) versus 6,2 (1221) mg/L (p=0,053). Using the three categories, 90% of the patients who have both elevated markers showed pathological vascular FDG-uptake, compared to 50% of patients with elevated ESR or CRP level and only 20% of patients with normal levels (p=0.011), see figure 1. Overall, the area under the curve (ROC) of the three groups of normal and/or high ESR and/or CRP increased from 0.731 (p=0,063) to 0.804 (p=0,014) after addition of the PET-CT scan.
As expected, lower ESR levels were measured in the group of patients who used corticosteroids compared to patients who did not use corticosteroids, respectively 35 ± 30 versus 78 ± 45 mm/hr (p=0.016). Use of corticosteroids was not related to FDG-uptake itself (p=0.680).
The PET-CT scan seems to have more additional value in patients suspected of vasculitis who have normal ESR or CRP levels compared to patients who have elevated levels of ESR and CRP. Corticosteroids decrease inflammatory markers in the peripheral blood, but do not seem to have a direct effect on FDG-uptake.
To cite this abstract, please use the following information:
Tang, Man Wai, Gerlag, Danielle Marie, Hak, A. Elisabeth, van Eck-Smit, Berthe L.F., Tak, Paul-Peter; The Value of Positron Emission Tomography Computed tomography in Patients with Large Vessel Vasculitis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :969