PET-Derived Increased Inflammation in Large Vessels is linked to Relapse-Free Survival in Patients with Giant Cell Arteritis

Abstract

Background Despite anti-inflammatory treatment, patients with giant cell arteritis (GCA) experience relapse. We aimed to determine respective relapse predictors focusing on [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG)-PET-based parameters.

Material and Methods 21 therapy-naïve GCA patients received [¹⁸F]FDG-PET/CT. Patients were divided in two groups: those who relapsed during course of disease and those who did not. Median follow up was 15 months. [¹⁸F]FDG-PET/CT was analyzed for visual (PET vascular activity score [VAS]) and quantitative parameters, including Target-to-background-Ratio with liver (TBR_liver) and jugular vein (TBR_jv) serving as reference tissues. In addition, clinical parameters were tested.

Results 8/21 (38.1 %) had relapse. Clinical parameters could not significantly discriminate between relapse vs no-relapse, including age (p = 0.9) or blood-based inflammatory markers (white blood cell counts [WBC] and c-reactive protein [CRP], p = 0.72, each). PETVAS score could also not differentiate between respective subgroups (p = 0.59). In a quantitative assessment, TBR_jv demonstrated a trend towards significance (p = 0.28). TBR_liver, however, separated between patients with and without relapse (p = 0.03).

Conclusion [¹⁸F]FDG PET quantification of vessels may be useful to identify GCA patients prone to relapse during follow-up.

Zusammenfassung

Hintergrund Patienten mit Riesenzellarteriitis (RZA) erleiden trotz immunsuppressiver Therapie häufig ein Rezidiv (Relapse). Wir haben deshalb untersucht, ob [¹⁸F]Fluordeoxyglucose ([¹⁸F]FDG) -PET-basierte Parameter geeignet sein könnten, um einen Relapse vorhersagen zu können.

Material und Methoden 21 therapienaive RZA-Patient*innen erhielten ein [¹⁸F]FDG-PET/CT. Die Patient*innen wurden dann in 2 Gruppen eingeteilt: Relapse und Non-Relapse. Die mediane Nachbeobachtungszeit betrug 15 Monate. Die [¹⁸F]FDG-PET/CTs wurden visuell (PET vascular activity score, VAS) und quantitativ analysiert, einschließlich der Target-to-Background-Ratio (TBR), wobei die Uptakes im Lebergewebe (TBR_Leber) und der Jugularvene (TBR_jv) als Referenz herangezogen wurden. Zusätzlich wurden klinische Parameter zum Baseline-Zeitpunkt untersucht.

Ergebnisse 8/21 (38,1 %) erlitten einen Relapse. Klinische Parameter konnten nicht zwischen Relapse und Non-Relapse unterscheiden (Alter (p = 0,9) bzw. Entzündungsmarker (Leukozyten und C-reaktives Protein, jeweils p = 0,72)). Auch der PETVAS-Score konnte nicht zwischen den beiden Gruppen differenzieren (p = 0,59). In einer quantitativen Analyse der PET zeigte die TBR_jv einen Trend zur Signifikanz (p = 0,28), wohingegen die TBR_Leber zwischen Relapse und Non-Relapse differenzieren konnte (p = 0,03).

Schlussfolgerung Eine quantitative Auswertung des [¹⁸F]FDG-PET/CT könnte helfen, um RZA-Patient*innen zu detektieren, die einen Relapse unter Therapie erleiden.

Key words

GCA - LVV - giant cell arteritis - PET - [¹⁸F]FDG - relapse

Schlüsselwörter

RZA - Riesenzellarteriitis - PET - [¹⁸F]FDG - Relapse

Publication History

Received: 06 November 2022

Accepted: 14 February 2023

Article published online:
04 September 2023

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