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Ha JW, Pyo JY, Ahn SS, Song JJ, Park YB, Lee SW. Application of the 2022 ACR/EULAR criteria for Takayasu arteritis to previously diagnosed patients based on the 1990 ACR criteria. Mod Rheumatol 2024; 34:1006-1012. [PMID: 39086077 DOI: 10.1093/mr/road105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/01/2023] [Indexed: 08/02/2024]
Abstract
OBJECTIVES Recently, a joint group of the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR) proposed new criteria for Takayasu arteritis (TAK) (the 2022 ACR/EULAR criteria). This study applied the 2022 ACR/EULAR criteria to patients with previously diagnosed TAK based on the 1990 ACR criteria and investigated the concordance rate between the two criteria according to the four imaging modalities. METHODS This study reviewed the medical records of 179 patients who met the 1990 ACR criteria for TAK. The imaging modalities included conventional angiography, computed tomography angiography, fluorodeoxyglucose-positron emission tomography, and magnetic resonance angiography. RESULTS Regardless of the imaging modalities, the concordance rate between the two criteria was 85.5% when including all patients, whereas it increased to 98.1% when only patients aged ≤60 years were included. Among the four imaging modalities, computed tomography angiography exhibited the highest concordance rate between the two criteria (85.6%). The concordance rate among patients aged >60 years was 95.7%. Only one patient aged 50-60 years was reclassified as having both TAK and giant cell arteritis. CONCLUSIONS The concordance rate was 85.5% regardless of the imaging modalities and increased to 86.9% on simultaneous computed tomography angiography and fluorodeoxyglucose-positron emission tomography imaging.
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Affiliation(s)
- Jang Woo Ha
- Department of Internal Medicine, Division of Rheumatology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Yoon Pyo
- Department of Internal Medicine, Division of Rheumatology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Ahn
- Department of Internal Medicine, Division of Rheumatology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jason Jungsik Song
- Department of Internal Medicine, Division of Rheumatology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Beom Park
- Department of Internal Medicine, Division of Rheumatology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Lee
- Department of Internal Medicine, Division of Rheumatology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
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Weng S, Li Y, Wang Q, Zhao Y, Zhou Y. Differentiation of lower limb vasculitis from physiological uptake on FDG PET/CT imaging. Ann Nucl Med 2023; 37:26-33. [PMID: 36306026 DOI: 10.1007/s12149-022-01800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/17/2022] [Indexed: 01/07/2023]
Abstract
PURPOSES To analyze the difference of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) uptake between vasculitis and non-vasculitic patients in PET/CT imaging and the factors related to vascular uptake in non-vasculitic patients. To investigate the feasibility of identifying vasculitis of the lower limb and physiological uptake with delayed imaging. PROCEDURES Among 244 patients who underwent PET/CT examination, imaging features of patients with or without vasculitis were retrospectively analyzed. The factors related to FDG uptake in the lower limb vessels of non-vasculitic patients were analyzed. Another 44 patients with suspected systemic vasculitis in PET/CT were prospectively studied to analyze the efficacy of delayed imaging on differentiating vascular uptake in lower limbs. RESULTS In PET/CT imaging of patients with vasculitis, involvement of trunk vessels showed segmental or diffuse FDG distribution. Lower limb vascular involvement showed reticular uptake accompanied by nodular or patchy changes. In non-vasculitic patients, vascular uptake mainly showed linear uptake in lower limb vessels and there was no significant difference in uptake degree compared with vasculitis patients. Body weight and interval time were the independent influence factors of vascular uptake in lower limbs of non-vasculitic patients. In delayed imaging, lower limb vasculitis all showed reticular uptake and physiological uptake all showed a linear pattern. ROC analysis showed the change rate of SUVmax (≥ 20%) between early and delayed imaging could delineate physiological vascular uptake with a sensitivity of 100% and specificity of 81.0%. CONCLUSIONS When PET/CT is used for the diagnosis and classification of vasculitis, the physiological uptake of lower limb vessels may mislead the diagnosis. PET/CT imaging features or delayed imaging improved diagnostic efficacy.
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Affiliation(s)
- Shijia Weng
- Department of Nuclear Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yuan Li
- Department of Nuclear Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Qian Wang
- Department of Nuclear Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Yunyun Zhao
- Department of Nuclear Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yunshan Zhou
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
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Murao M, Norikane T, Chujo K, Takami Y, Mitamura K, Hanae AO, Yamamoto Y, Maeda Y, Dobashi H, Nishiyama Y. Clinical significance of PET angiography in Takayasu arteritis. J Nucl Cardiol 2022; 29:3576-3578. [PMID: 33890186 DOI: 10.1007/s12350-021-02619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Mitsumasa Murao
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Takashi Norikane
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Kanako Chujo
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yasukage Takami
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Katsuya Mitamura
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Arai-Okuda Hanae
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yuka Yamamoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yukito Maeda
- Department of Clinical Radiology, Kagawa University Hospital, Kita-gun, Kagawa, Japan
| | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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Kwon OC, Park MC. Derivation and Validation of a New Disease Activity Assessment Tool With Higher Accuracy for Takayasu Arteritis. Front Immunol 2022; 13:925341. [PMID: 35784279 PMCID: PMC9248800 DOI: 10.3389/fimmu.2022.925341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To develop a new disease activity assessment tool with high accuracy for Takayasu arteritis. Methods Individual items from National Institute of Health (NIH) criteria and the Indian Takayasu Clinical Activity Score (ITAS2010) were tested as candidate variables to develop a new disease activity assessment tool in a derivation cohort (N = 100). Physician global assessment on disease activity was used as the gold standard. Multivariable logistic regression models were constructed and the model with the highest accuracy was identified. A formula assessing disease activity was generated using simplified β coefficients (rounded to decimal place). Diagnostic performance was evaluated through estimating the area under the curve (AUC). The new assessment tool was subsequently validated in a validation cohort (N = 46). Results The multivariable model yielding the highest accuracy consisted of a high erythrocyte sedimentation rate (ESR), NIH criteria 1 and 4, and carotidynia. Using simplified β coefficients, the following disease activity assessment tool was developed: high ESR (3 points), NIH criterion 1 (2 points), NIH criterion 4 (4 points), and carotidynia (3 points) (total score ≥5, active; total score <5, inactive). The new disease activity assessment tool had a higher AUC (89.37) for discriminating active and inactive diseases than NIH criteria (AUC 77.96), ITAS2010 (AUC 66.12), ITAS-ESR (AUC 75.58), and ITAS-C-reactive protein (AUC 71.34). The AUC (85.23) of the new assessment tool was similar in the validation cohort. Conclusion A new disease activity assessment tool that consists of high ESR, NIH criteria 1 and 4, and carotidynia had higher accuracy in discriminating active and inactive disease than currently used clinical assessment tools.
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de Souza Santos MP, Ramos CD, Paixão M, Pignaton Naseri E, Barros Bertolo M, Sachetto Z. 18F-FDG PET/CT in Late Acquisition Identifies Sites of Active Disease in Treated Takayasu Arteritis. J Clin Rheumatol 2022; 28:14-20. [PMID: 34941616 PMCID: PMC8746893 DOI: 10.1097/rhu.0000000000001801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Few studies have taken advantage of 18F-fluorodeoxyglucose positron emission tomography associated with computed tomography (18F-FDG PET/CT) to personalize patient evaluation and identify sites of more active disease in Takayasu arteritis (TA)-treated patients. This study aimed to evaluate the utility of 18F-FDG PET/CT in late acquisition in identifying sites of active disease in patients under full treatment for TA. METHODS In this cross-sectional study, patients under full treatment underwent whole-body 18F-FDG PET/CT. Sites of increased 18F-FDG uptake were classified by a score of 3 on the visual scale using the liver uptake as reference. A quantitative analysis was also performed by measuring the maximum standardized uptake value (SUV) of the vascular wall of affected arteries. Disease activity using the National Institutes of Health criteria was also evaluated. RESULTS Of the 20 patients, there were 18 female and 2 male patients, with a mean age of 43.6 (±11.58) years and a disease duration of 8.3 (±6.25) years. Thirteen participants (65%) were in inflammatory activity according to the criteria proposed by the National Institutes of Health. All patients received immunosuppressive agents, and one of them received immunobiological treatment. The highest SUV value was 6.2 in the aortic arch, and the lowest was 1.0 in the subclavian artery. The mean maximum SUV did not differ between clinically active and inactive patients. In the visual analysis, all participants had at least 1 vascular site with inflammatory activity, with an uptake ≥2 in relation to the liver. The aortic arch was the most frequently involved site. CONCLUSIONS This study showed that 18F-FDG PET/CT in late acquisition is an effective imaging method to assess TA activity even in fully treated patients.
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Oura K, Yamaguchi Oura M, Itabashi R, Maeda T. Vascular Imaging Techniques to Diagnose and Monitor Patients with Takayasu Arteritis: A Review of the Literature. Diagnostics (Basel) 2021; 11:diagnostics11111993. [PMID: 34829340 PMCID: PMC8620366 DOI: 10.3390/diagnostics11111993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/16/2021] [Accepted: 10/25/2021] [Indexed: 12/18/2022] Open
Abstract
Takayasu arteritis (TA) is a large vessel vasculitis that causes stenosis, occlusion, and sometimes the aneurysm of the aorta and its major branches. TA often occurs in young women, and because the symptoms are not obvious in the early stages of the disease, diagnosis is difficult and often delayed. In approximately 10% to 20% of patients, TA is reportedly complicated by ischemic stroke or transient ischemic attack. It is important to diagnose TA early and provide appropriate treatment to prevent complications from stroke. Diagnostic imaging techniques to visualize arterial stenosis are widely used in clinical practice. Even if no signs of cerebrovascular events are present at the time of the most recent evaluation of patients with TA, follow-up vascular imaging is important to monitor disease progression and changes in the cerebrovascular risk. However, the optimal imaging technique for monitoring of TA has not been established. Therefore, the purpose of this review is to describe newly available evidence on the usefulness of conventional imaging modalities (digital subtraction angiography, computed tomography angiography, magnetic resonance imaging/angiography, duplex ultrasound, and positron emission tomography) and novel imaging modalities (optical coherence tomography, infrared thermography, contrast-enhanced ultrasonography, and superb microvascular imaging) in the diagnosis and monitoring of TA.
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Kwon OC, Jeon TJ, Park MC. Vascular Uptake on 18F-FDG PET/CT During the Clinically Inactive State of Takayasu Arteritis Is Associated with a Higher Risk of Relapse. Yonsei Med J 2021; 62:814-821. [PMID: 34427067 PMCID: PMC8382731 DOI: 10.3349/ymj.2021.62.9.814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate whether vascular uptake on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) during the clinically inactive state of Takayasu arteritis (TAK) is associated with disease relapse. MATERIALS AND METHODS Patients with TAK who underwent 18F-FDG PET/CT during the clinically inactive state of the disease between 2006 and 2019 were included. Clinically inactive disease was defined as a status not fulfilling the National Institutes of Health (NIH) criteria for active disease in TAK. Relapse was defined as recurrence of clinically active disease after a clinically inactive period, requiring change in the treatment regimen. Vascular uptake on 18F-FDG PET/CT was assessed using target/background ratio (TBR), calculated as arterial maximum standardized uptake value (SUV)/mean SUV in venous blood pool. Multivariable Cox regression analysis was performed to identify factors associated with relapse. RESULTS A total of 33 patients with clinically inactive TAK were included. During a median observation period of 4.5 (0.9-8.1) years, relapse occurred in 9 (27.3%) patients at median 1.3 (0.7-6.9) years. Notably, TBR [1.5 (1.3-1.8) vs. 1.3 (1.1-1.4), p=0.044] was significantly higher in patients who relapsed than in those who did not. On multivariable Cox regression analysis, the presence of NIH criterion 2 [adjusted hazard ratio (HR): 7.044 (1.424-34.855), p=0.017] and TBR [adjusted HR: 11.533 (1.053-126.282), p=0.045] were significantly associated with an increased risk of relapse. CONCLUSION Vascular uptake on 18F-FDG PET/CT and the presence of NIH criterion 2 are associated with future relapse in patients with clinically inactive TAK.
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Affiliation(s)
- Oh Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Joo Jeon
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Maz M, Chung SA, Abril A, Langford CA, Gorelik M, Guyatt G, Archer AM, Conn DL, Full KA, Grayson PC, Ibarra MF, Imundo LF, Kim S, Merkel PA, Rhee RL, Seo P, Stone JH, Sule S, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot MA, Lin YC, Springer JM, Turgunbaev M, Villa-Forte A, Turner AS, Mustafa RA. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis. Arthritis Rheumatol 2021; 73:1349-1365. [PMID: 34235884 DOI: 10.1002/art.41774] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/24/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To provide evidence-based recommendations and expert guidance for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) as exemplars of large vessel vasculitis. METHODS Clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for GCA and TAK (27 for GCA, 27 for TAK). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. Recommendations were developed by the Voting Panel, comprising adult and pediatric rheumatologists and patients. Each recommendation required ≥70% consensus among the Voting Panel. RESULTS We present 22 recommendations and 2 ungraded position statements for GCA, and 20 recommendations and 1 ungraded position statement for TAK. These recommendations and statements address clinical questions relating to the use of diagnostic testing, including imaging, treatments, and surgical interventions in GCA and TAK. Recommendations for GCA include support for the use of glucocorticoid-sparing immunosuppressive agents and the use of imaging to identify large vessel involvement. Recommendations for TAK include the use of nonglucocorticoid immunosuppressive agents with glucocorticoids as initial therapy. There were only 2 strong recommendations; the remaining recommendations were conditional due to the low quality of evidence available for most PICO questions. CONCLUSION These recommendations provide guidance regarding the evaluation and management of patients with GCA and TAK, including diagnostic strategies, use of pharmacologic agents, and surgical interventions.
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Affiliation(s)
- Mehrdad Maz
- University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | | | | | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | - Susan Kim
- University of California, San Francisco
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Ann Warner
- Saint Luke's Health System, Kansas City, Missouri
| | | | | | | | | | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Reem A Mustafa
- University of Kansas Medical Center, Kansas City, and McMaster University, Hamilton, Ontario, Canada
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9
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Maz M, Chung SA, Abril A, Langford CA, Gorelik M, Guyatt G, Archer AM, Conn DL, Full KA, Grayson PC, Ibarra MF, Imundo LF, Kim S, Merkel PA, Rhee RL, Seo P, Stone JH, Sule S, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot MA, Lin YC, Springer JM, Turgunbaev M, Villa-Forte A, Turner AS, Mustafa RA. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis. Arthritis Care Res (Hoboken) 2021; 73:1071-1087. [PMID: 34235871 DOI: 10.1002/acr.24632] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/24/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To provide evidence-based recommendations and expert guidance for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) as exemplars of large vessel vasculitis. METHODS Clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for GCA and TAK (27 for GCA, 27 for TAK). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. Recommendations were developed by the Voting Panel, comprising adult and pediatric rheumatologists and patients. Each recommendation required ≥70% consensus among the Voting Panel. RESULTS We present 22 recommendations and 2 ungraded position statements for GCA, and 20 recommendations and 1 ungraded position statement for TAK. These recommendations and statements address clinical questions relating to the use of diagnostic testing, including imaging, treatments, and surgical interventions in GCA and TAK. Recommendations for GCA include support for the use of glucocorticoid-sparing immunosuppressive agents and the use of imaging to identify large vessel involvement. Recommendations for TAK include the use of nonglucocorticoid immunosuppressive agents with glucocorticoids as initial therapy. There were only 2 strong recommendations; the remaining recommendations were conditional due to the low quality of evidence available for most PICO questions. CONCLUSION These recommendations provide guidance regarding the evaluation and management of patients with GCA and TAK, including diagnostic strategies, use of pharmacologic agents, and surgical interventions.
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Affiliation(s)
- Mehrdad Maz
- University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | | | | | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | - Susan Kim
- University of California, San Francisco
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Ann Warner
- Saint Luke's Health System, Kansas City, Missouri
| | | | | | | | | | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Reem A Mustafa
- University of Kansas Medical Center, Kansas City, and McMaster University, Hamilton, Ontario, Canada
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Dashora HR, Rosenblum JS, Quinn KA, Alessi H, Novakovich E, Saboury B, Ahlman MA, Grayson P. Comparing Semi-quantitative and Qualitative Methods of Vascular FDG-PET Activity Measurement in Large-Vessel Vasculitis. J Nucl Med 2021; 63:280-286. [PMID: 34088771 DOI: 10.2967/jnumed.121.262326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
The study rationale was to assess the performance of qualitative and semi-quantitative scoring methods for 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) assessment in large-vessel vasculitis (LVV). Methods: Patients with giant cell arteritis (GCA) or Takayasu's arteritis (TAK) underwent clinical and imaging assessment, blinded to each other, within a prospective observational cohort. FDG-PET-CT scans were interpreted for active vasculitis by central reader assessment. Arterial FDG uptake was scored by qualitative visual assessment using the PET vascular activity score (PETVAS) and by semi-quantitative assessment using standardized uptake values (SUV) and target-to-background ratios (TBR) relative to liver/blood activity. Performance of each scoring method was assessed by intra-rater reliability using the intra-class coefficient (ICC) and area under receiver-operator characteristic curves (AUC), using physician assessment of clinical disease activity and reader interpretation of vascular PET activity as independent reference standards. Wilcoxon signed-rank test was used to analyze change in arterial FDG uptake over time. Results: Ninety-five patients (GCA=52; TAK=43) contributed 212 FDG-PET studies. The ICC for semi-quantitative evaluation [0.99 (range 0.98-1.00)] was greater than the ICC for qualitative evaluation [0.82 (range 0.56-0.93)]. PETVAS and TBR metrics were more strongly associated with reader interpretation of PET activity than SUV metrics. All assessment methods were significantly associated with physician assessment of clinical disease activity, but the semi-quantitative metric TBRLiver¬ achieved the highest AUC (0.66). Significant but weak correlations with C-reactive protein were observed for SUV metrics (r = 0.19, p<0.01) and TBRLiver (r = 0.20, p<0.01) but not for PETVAS. In response to increased treatment in 56 patients, arterial FDG uptake was significantly reduced when measured by semi-quantitative (TBRLiver 1.31 to 1.23, 6.1% ∆, p<0.0001) or qualitative (PETVAS 22 to 18, p<0.0001) methods. Semi-quantitative metrics provided complementary information to qualitative evaluation in cases of severe vascular inflammation. Conclusion: Both qualitative and semi-quantitative methods to measure arterial FDG uptake are useful to assess and monitor vascular inflammation in LVV. Compared to qualitative metrics, semi-quantitative methods have superior reliability and better discriminate treatment response in cases of severe inflammation.
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Affiliation(s)
- Himanshu R Dashora
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
| | - Joel S Rosenblum
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
| | - Kaitlin A Quinn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
| | - Hugh Alessi
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
| | - Elaine Novakovich
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
| | - Babak Saboury
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health
| | - Mark A Ahlman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health
| | - Peter Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
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Betrains A, Blockmans D. Diagnostic Approaches for Large Vessel Vasculitides. Open Access Rheumatol 2021; 13:153-165. [PMID: 34113183 PMCID: PMC8183517 DOI: 10.2147/oarrr.s282605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
The large vessel vasculitides comprise giant cell arteritis (GCA), Takayasu arteritis (TAK), and chronic periaortitis. The diagnostic approach to these conditions involves the correct use and interpretation of clinical criteria, imaging techniques, and, in case of GCA, temporal artery biopsy. Ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) reveal a homogeneous, concentric, thickening of the arterial wall. MRI and CT may also reveal aneurysms and stenoses. 18F-Fluorodeoxyglucose (FDG)-PET shows increased FDG uptake of inflamed artery walls delineating increased metabolic activity. Ultrasound, FDG-PET, and MRI are the recommended imaging techniques in GCA and TAK. In patients with a high suspicion of GCA who present with visual disturbances, initiation of high-dose intravenous corticosteroids should not be delayed by imaging. Extracranial large vessel vasculitis may be confirmed by all three modalities, particularly by FDG-PET in case of atypical clinical pictures. In this article, we review the role of the GCA and TAK ACR classification criteria, temporal artery biopsy, conventional angiography, ultrasound, MRI, magnetic resonance angiography (MRA), CT angiography (CTA), and FDG-PET in the diagnostic approach of large vessel vasculitis.
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Affiliation(s)
- Albrecht Betrains
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Daniel Blockmans
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
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Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2021; 48:3886-3902. [PMID: 33942141 PMCID: PMC8484162 DOI: 10.1007/s00259-021-05362-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/06/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Monitoring disease activity in patients with large vessel vasculitis (LVV) can be challenging. [18F]FDG-PET/CT is increasingly used to evaluate treatment response in LVV. In this systematic review and meta-analysis, we aimed to summarize the current evidence on the value of [18F]FDG-PET/CT for treatment monitoring in LVV. METHODS PubMed/MEDLINE and the Cochrane library database were searched from inception through October 21, 2020. Studies containing patients with LVV (i.e. giant cell arteritis, Takayasu arteritis and isolated aortitis) that received treatment and underwent [18F]FDG-PET/CT were included. Screening, full-text review and data extraction were performed by 2 investigators. The risk of bias was examined with the QUADAS-2 tool. Meta-analysis of proportions and diagnostic test accuracy was performed by a random-effects model and bivariate model, respectively. RESULTS Twenty-one studies were included in the systematic review, of which 8 studies were eligible for meta-analysis. Arterial [18F]FDG uptake decreased upon clinical remission in longitudinal studies. High heterogeneity (I2 statistic 94%) precluded meta-analysis of the proportion of patients in which the scan normalized during clinical remission. Meta-analysis of cross-sectional studies indicated that [18F]FDG-PET/CT may detect relapsing/refractory disease with a sensitivity of 77% (95%CI 57-90%) and specificity of 71% (95%CI 47-87%). Substantial heterogeneity was observed among the cross-sectional studies. Both variation in clinical aspects and imaging procedures contributed to the heterogeneity. CONCLUSION Treatment of LVV leads to reduction of arterial [18F]FDG uptake during clinical remission. [18F]FDG-PET/CT has moderate diagnostic accuracy for detecting active LVV. [18F]FDG-PET/CT may aid treatment monitoring in LVV, but its findings should be interpreted in the context of the clinical suspicion of disease activity. This study underlines the relevance of published procedural recommendations for the use of [18F]FDG-PET/CT in LVV.
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Sato W, Suto Y, Yamanaka T, Watanabe H. An advanced ultrasound application used to assess peripheral vascular diseases: superb microvascular imaging. J Echocardiogr 2021; 19:150-157. [PMID: 33856650 DOI: 10.1007/s12574-021-00527-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
Over the past several years, a novel ultrasound imaging modality termed superb microvascular imaging (SMI) has enabled visualization of microvessels. SMI ultrasound studies of peripheral artery diseases have significantly extended our knowledge of tissue microcirculation and the arterial microenvironments of atherosclerotic lesions. We here present an overview of current knowledge on the utility of SMI assessment of vascular diseases and highlight certain peripheral microcirculation disorders for which SMI is particularly valuable. The evidence indicates that SMI can detect intraplaque neovascularization and usefully assess carotid plaque vulnerability; vascularization of the carotid arterial wall detected by SMI is a potential marker of disease activity in patients with Takayasu arteritis; SMI reveals the foot microcirculation and yields a quantitative vascular index (in line with the angiosome concept); and, SMI may serve as an auxiliary diagnostic modality for hereditary hemorrhagic telangiectasia and Raynaud syndrome. In general, microcirculatory evaluation by SMI is an attractive field for future research on therapeutic strategies for peripheral vascular diseases.
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Affiliation(s)
- Wakana Sato
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan
| | - Yuta Suto
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan
| | - Takayuki Yamanaka
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan.
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18F-FDG PET/CT plays a unique role in the management of Takayasu arteritis patients with atypical manifestations. Clin Rheumatol 2020; 40:625-633. [PMID: 32562071 DOI: 10.1007/s10067-020-05028-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/01/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The present study aimed to evaluate the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) aiding in diagnosing and evaluating disease activity in Takayasu arteritis (TA) patients with atypical clinical manifestations. METHODS A retrospective study of 22 TA patients was conducted. All the participants were classified into two groups. Group one including 12 patients, who did not fulfill American College of Rheumatology (ACR) criteria, were diagnosed by modified Ishikawa criteria. Group two involving ten patients, who did not satisfy the modified Ishikawa criteria or ACR criteria, were clinically diagnosed as TA after panel discussion by a combination of clinical data, excluding other diagnoses. PET/CT results were analyzed using quantitative and qualitative metrics. Disease activity was evaluated using the US National Institutes of Health (NIH) criteria. RESULTS In group one, nine patients in active stage and two patients in inactive stage had active FDG uptake. One patient in inactive stage had inactive PET/CT results. In group two, five patients in active stage had active FDG uptake and five patients in inactive stage had inactive FDG uptake with SUVmax values of several vascular lesions slightly lower than livermean in each person. The sensitivity of PET/CT scans for evaluating disease activity was 100.0%, specificity was 75.0%, positive predictive value was 87.5%, and negative predictive value was 100.0% compared to NIH criteria. CONCLUSIONS PET/CT plays a unique role in diagnosing these TA with atypical manifestation and assisting in evaluating disease activity. Key Points • Diagnosis of these TA patients with atypical manifestations may be difficult. • PET/CT plays a unique role in diagnosing these TA patients and assisting in evaluating disease activity.
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TAKAYASU ARTERİTİNDE TEK MERKEZ DENEYİMİ. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.648730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Janes ALF, Castro MF, Arraes AED, Savioli B, Sato EI, de Souza AWS. A retrospective cohort study to assess PET-CT findings and clinical outcomes in Takayasu arteritis: does 18F-fluorodeoxyglucose uptake in arteries predict relapses? Rheumatol Int 2020; 40:1123-1131. [DOI: 10.1007/s00296-020-04551-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/11/2020] [Indexed: 12/19/2022]
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[Positron emission tomography/computed tomography in rheumatology]. Z Rheumatol 2019; 76:566-573. [PMID: 28664283 DOI: 10.1007/s00393-017-0345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Combined positron emission tomography/computed tomography (PET/CT) is a whole-body imaging procedure, which enables sensitive detection of inflammatory changes. It may be used to simultaneously obtain both precise anatomical and molecular information in order to comprehensively characterize diseases. The glucose analogue 18F-fluorodeoxyglucose (FDG) represents a universally applicable radiotracer for imaging of inflammatory processes. Its accumulation in tissues can be semiquantitatively characterized by use of standardized uptake values (SUV). In principle, a broad spectrum of infectious and non-infectious inflammatory and malignant diseases can be imaged. 18F-FDG PET/CT has become a valuable modality and is increasingly being used for evaluation of large vessel vasculitis and for evaluation of elevated systemic inflammatory markers without known cause. Beside the radiotracer 18F-FDG, other radiopharmaceuticals enable a non-invasive analysis of additional parameters of inflammatory disorders, such as other metabolic pathways or the expression of surface receptors.
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Li Z, Zheng Z, Ding J, Li X, Zhao Y, Kang F, Li Y, Pang L, Du W, Wu Z, Zhu P. Contrast-enhanced Ultrasonography for Monitoring Arterial Inflammation in Takayasu Arteritis. J Rheumatol 2019; 46:616-622. [PMID: 30824642 DOI: 10.3899/jrheum.180701] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the utility of contrast-enhanced ultrasound (CEUS) compared with 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in assessing vessel inflammation of Takayasu arteritis (TA). METHODS This is a retrospective analysis of 71 patients with TA who had undergone carotid CEUS. Twenty-two of 71 patients underwent FDG-PET after CEUS. Clinical disease activity was assessed by Kerr criteria and the Indian Takayasu Clinical Activity Score 2010 (ITAS2010). We investigated the correlation between carotid vascularization on CEUS and clinical data. The consistency of carotid CEUS and PET data has been analyzed for TA disease activity. RESULTS There was a statistically significant correlation between the results of CEUS and ITAS2010 (p = 0.004) or Kerr criteria (p < 0.001). According to ITAS2010, thirty-four of 71 patients with TA were clinically inactive. Assessment of 34 TA patients with clinically inactive disease yielded 11 CEUS scans that showed active lesions (visual grade ≥ 2) in the left or right carotid artery. In 22 cases that underwent CEUS and FDG-PET, 12 were active and 10 were inactive on the basis of ITAS2010. Moreover, bilateral carotid CEUS vascularization score positively correlated with vascular FDG uptake in these patients with TA (p = 0.004). When vascular inflammation was defined as FDG uptake with visual grade ≥ 2, carotid CEUS showed sensitivity of 100% and specificity of 80%. CONCLUSION For TA patients with clinically inactive disease, CEUS could help clinicians to identify active lesions in the carotid vascular region. Carotid CEUS may be a rapid and cost-effective imaging tool in the followup of patients with TA.
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Affiliation(s)
- ZhiQin Li
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - ZhaoHui Zheng
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Jin Ding
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - XiaoFeng Li
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - YongFeng Zhao
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Fei Kang
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Ying Li
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - LinXuan Pang
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - WangLei Du
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - ZhenBiao Wu
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Ping Zhu
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China. .,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work.
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The Role of Vascular Imaging to Advance Clinical Care and Research in Large-Vessel Vasculitis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019; 5:20-35. [PMID: 31598465 DOI: 10.1007/s40674-019-00114-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose of the Review The two main forms of large-vessel vasculitis (LVV) are giant cell arteritis (GCA) and Takayasu's arteritis (TAK). Vascular imaging can characterize disease activity and disease extent in LVV. This review critically analyzes the clinical utility of vascular imaging in LVV and highlights how imaging may be incorporated into the management and study of these conditions. Recent Findings There are multiple imaging modalities available to assess LVV including ultrasonography, CT angiography (CTA), magnetic resonance angiography (MRA), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). As these techniques are refined, imaging may be increasingly useful to evaluate the cranial arteries and the aorta and its primary branches. In addition, vascular imaging may be useful to monitor disease activity and may have prognostic value to predict future clinical events. Summary There are strengths and weaknesses associated with vascular imaging that should be considered when evaluating patients with LVV. Vascular imaging will likely play an increasingly important role in the clinical management of patients and the conduct of research in LVV and may ultimately be incorporated as outcome measures in clinical trials in these conditions.
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Lee SW, Kim SJ, Seo Y, Jeong SY, Ahn BC, Lee J. F-18 FDG PET for assessment of disease activity of large vessel vasculitis: A systematic review and meta-analysis. J Nucl Cardiol 2019; 26:59-67. [PMID: 30120746 DOI: 10.1007/s12350-018-1406-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of this study is to investigate the performance of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) or positron emission tomography/computed tomography (PET/CT) for the assessment of disease activity in patients with large vessel vasculitis (LVV) through a meta-analysis. METHODS The MEDLINE via PubMed and EMBASE were searched for the studies evaluating the performance of F-18 FDG PET or PET/CT in the assessment of disease activity in patients with LVV. Pooled sensitivity, specificity, diagnostic odds ratios (DORs), and summary receiver-operating characteristic (sROC) curve were estimated across the included studies. Possible publication bias was assessed by Deek's funnel plot asymmetry tests. RESULTS A total of 439 PET images from 298 patients pooled from nine studies showed that the pooled sensitivity was 0.88 [95% confidence interval (CI) 0.79-0.93] without heterogeneity (χ2 = 14.42, P = .07) and the pooled specificity was 0.81 (95% CI 0.64-0.91) with heterogeneity (χ2 = 63.72, P = .00) for the detection of active LVV. The pooled DOR was 30 (95% CI 8-107). Hierarchical sROC curve indicates that the area under the curve was 0.91 (95% CI 0.89-0.94). There was no significant publication bias (P = .42), and meta-regression analysis revealed that none of the variables was the source of the study heterogeneity. CONCLUSIONS F-18 FDG PET has a good performance for the detection of active disease status in patients with LVV. Revised criteria for the assessment of disease activity incorporated with F-18 FDG PET or PET/CT should be introduced and validated. Further studies are warranted to determine if PET-based treatment of LVV can improve outcomes.
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Affiliation(s)
- Sang-Woo Lee
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Taegu, South Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, South Korea.
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 50612, South Korea.
| | - Youngduk Seo
- Department of Nuclear Medicine, Busan Seongso Hospital, Pusan, South Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Taegu, South Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Taegu, South Korea
| | - Jaetae Lee
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Taegu, South Korea
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Schramm N, Ingenhoff J, Dechant C, Treitl KM, Treitl M, Proft F, Schulze-Koops H, Hoffmann U, Bartenstein P, Rominger A, Czihal M. Diagnostic accuracy of positron emission tomography for assessment of disease activity in large vessel vasculitis. Int J Rheum Dis 2018; 22:1371-1377. [PMID: 30565885 DOI: 10.1111/1756-185x.13440] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/23/2018] [Accepted: 10/18/2018] [Indexed: 01/18/2023]
Abstract
AIM To determine the diagnostic yield of 18 F-fluorodeoxyglucose positron emission tomography (PET) in disease activity assessment of large vessel vasculitides (LVV). METHODS Patients with LVV who had undergone PET (between 2004 and June 2010) or PET co-registered with computed tomography (PET/CT; since June 2010) were identified. Clinical disease activity was assessed using established scoring systems. PET images were reviewed by two blinded nuclear medicine physicians. Uptake of the aortic wall was compared to the liver uptake utilizing a visual 4-point score, with a vessel wall uptake similar or higher than liver uptake considered as active disease. Various target-to-background ratios were calculated. Receiver operator characteristics analysis was applied to determine the diagnostic accuracy of PET for detecting clinically active disease. Interobserver agreement of visual readings was measured with Cohen´s kappa. RESULTS Eighty examinations in 62 patients were analyzed, with a mean time between diagnosis and PET of 106 ± 171 weeks. Fifty-seven cases were finally classified as clinically active and 23 cases as clinically inactive. With a cut-off value of 1.3, the aorta-to-liver ratio yielded a sensitivity and specificity of 84.2% and 82.6% (area under the curve 0.9). Overall, sensitivity and specificity of visual analysis were 68.4% and 91.3%, but sensitivity decreased to 54% in patients treated for more than 3 months. Interobserver agreement of visual rating was excellent (κ: 0.93). CONCLUSION Positron emission tomography is specific and reliable in disease activity assessment of LVV, but lacks sensitivity for detecting active disease in patients under long-term immunosuppressive treatment.
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Affiliation(s)
- Nicolai Schramm
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Janina Ingenhoff
- Division of Vascular Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Claudia Dechant
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Karla-Maria Treitl
- Department of Radiology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Marcus Treitl
- Department of Radiology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Fabian Proft
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Czihal
- Division of Vascular Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Comparison between visual and numerical metrics for the evaluation of patients with Takayasu arteritis with 18F-FDG-PET. Nucl Med Commun 2018; 39:779-788. [DOI: 10.1097/mnm.0000000000000867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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23
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Quinn KA, Ahlman MA, Malayeri AA, Marko J, Civelek AC, Rosenblum JS, Bagheri AA, Merkel PA, Novakovich E, Grayson PC. Comparison of magnetic resonance angiography and 18F-fluorodeoxyglucose positron emission tomography in large-vessel vasculitis. Ann Rheum Dis 2018; 77:1165-1171. [PMID: 29666047 DOI: 10.1136/annrheumdis-2018-213102] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess agreement between interpretation of magnetic resonance angiography (MRA) and 18F-fluorodeoxyglucose positron emission tomography (PET) for disease extent and disease activity in large-vessel vasculitis (LVV) and determine associations between imaging and clinical assessments. METHODS Patients with giant cell arteritis (GCA), Takayasu's arteritis (TAK) and comparators were recruited into a prospective, observational cohort. Imaging and clinical assessments were performed concurrently, blinded to each other. Agreement was assessed by per cent agreement, Cohen's kappa and McNemar's test. Multivariable logistic regression identified MRA features associated with PET scan activity. RESULTS Eighty-four patients (GCA=35; TAK=30; comparator=19) contributed 133 paired studies. Agreement for disease extent between MRA and PET was 580 out of 966 (60%) arterial territories with Cohen's kappa=0.22. Of 386 territories with disagreement, MRA demonstrated disease in more territories than PET (304vs82, p<0.01). Agreement for disease activity between MRA and PET was 90 studies (68%) with Cohen's kappa=0.30. In studies with disagreement, MRA demonstrated activity in 23 studies and PET in 20 studies (p=0.76). Oedema and wall thickness on MRA were independently associated with PET scan activity. Clinical status was associated with disease activity by PET (p<0.01) but not MRA (p=0.70), yet 35/69 (51%) patients with LVV in clinical remission had active disease by both MRA and PET. CONCLUSIONS In assessment of LVV, MRA and PET contribute unique and complementary information. MRA better captures disease extent, and PET scan is better suited to assess vascular activity. Clinical and imaging-based assessments often do not correlate over the disease course in LVV. TRIAL REGISTRATION NUMBER NCT02257866.
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Affiliation(s)
- Kaitlin A Quinn
- Division of Rheumatology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, Maryland, USA
| | - Mark A Ahlman
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland, USA
| | - Ashkan A Malayeri
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland, USA
| | - Jamie Marko
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland, USA
| | - Ali Cahid Civelek
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland, USA
| | - Joel S Rosenblum
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, Maryland, USA
| | - Armin A Bagheri
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, Maryland, USA
| | - Peter A Merkel
- Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elaine Novakovich
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, Maryland, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, Maryland, USA
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FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging 2018; 45:1250-1269. [PMID: 29637252 PMCID: PMC5954002 DOI: 10.1007/s00259-018-3973-8] [Citation(s) in RCA: 286] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 02/07/2023]
Abstract
Large vessel vasculitis (LVV) is defined as a disease mainly affecting the large arteries, with two major variants, Takayasu arteritis (TA) and giant cell arteritis (GCA). GCA often coexists with polymyalgia rheumatica (PMR) in the same patient, since both belong to the same disease spectrum. FDG-PET/CT is a functional imaging technique which is an established tool in oncology, and has also demonstrated a role in the field of inflammatory diseases. Functional FDG-PET combined with anatomical CT angiography, FDG-PET/CT(A), may be of synergistic value for optimal diagnosis, monitoring of disease activity, and evaluating damage progression in LVV. There are currently no guidelines regarding PET imaging acquisition for LVV and PMR, even though standardization is of the utmost importance in order to facilitate clinical studies and for daily clinical practice. This work constitutes a joint procedural recommendation on FDG-PET/CT(A) imaging in large vessel vasculitis (LVV) and PMR from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine (EANM), the Cardiovascular Council of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), and the PET Interest Group (PIG), and endorsed by the American Society of Nuclear Cardiology (ASNC). The aim of this joint paper is to provide recommendations and statements, based on the available evidence in the literature and consensus of experts in the field, for patient preparation, and FDG-PET/CT(A) acquisition and interpretation for the diagnosis and follow-up of patients with suspected or diagnosed LVV and/or PMR. This position paper aims to set an internationally accepted standard for FDG-PET/CT(A) imaging and reporting of LVV and PMR.
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Sun Y, Huang Q, Jiang L. Radiology and biomarkers in assessing disease activity in Takayasu arteritis. Int J Rheum Dis 2018; 22 Suppl 1:53-59. [PMID: 29624875 DOI: 10.1111/1756-185x.13286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Ying Sun
- Department of Rheumatology; Zhongshan Hospital; Fudan University; Shanghai China
| | - Qingrong Huang
- Department of Rheumatology; Zhongshan Hospital; Fudan University; Shanghai China
| | - Lindi Jiang
- Department of Rheumatology; Zhongshan Hospital; Fudan University; Shanghai China
- Center of Evidence-based Medicine; Fudan University; Shanghai China
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Tombetti E, Mason JC. Takayasu arteritis: advanced understanding is leading to new horizons. Rheumatology (Oxford) 2018; 58:206-219. [DOI: 10.1093/rheumatology/key040] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Enrico Tombetti
- Department of Immunology, Transplantation and Infections Disease, Vita-Salute San Raffaele University and San Raffaele Scientific Institute, Milan, Italy
- Vascular Sciences and Rheumatology, Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
| | - Justin C Mason
- Vascular Sciences and Rheumatology, Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
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Grayson PC, Alehashemi S, Bagheri AA, Civelek AC, Cupps TR, Kaplan MJ, Malayeri AA, Merkel PA, Novakovich E, Bluemke DA, Ahlman MA. 18 F-Fluorodeoxyglucose-Positron Emission Tomography As an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients With Large Vessel Vasculitis. Arthritis Rheumatol 2018; 70:439-449. [PMID: 29145713 DOI: 10.1002/art.40379] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/10/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the clinical value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in a prospective cohort of patients with large vessel vasculitis (LVV) and comparator subjects. METHODS Patients with Takayasu arteritis and giant cell arteritis were studied, along with a comparator group consisting of patients with hyperlipidemia, patients with diseases that mimic LVV, and healthy controls. Participants underwent clinical evaluation and FDG-PET imaging, and patients with LVV underwent serial imaging at 6-month intervals. We calculated sensitivity and specificity of FDG-PET interpretation for distinguishing patients with clinically active LVV from comparator subjects and from patients with disease in clinical remission. A qualitative summary score based on global arterial FDG uptake, the PET Vascular Activity Score (PETVAS), was used to study associations between activity on PET scan and clinical characteristics and to predict relapse. RESULTS A total of 170 FDG-PET scans were performed in 115 participants (56 patients with LVV and 59 comparator subjects). FDG-PET distinguished patients with clinically active LVV from comparator subjects with a sensitivity of 85% (95% confidence interval [95% CI] 69, 94) and a specificity of 83% (95% CI 71, 91). FDG-PET scans were interpreted as active vasculitis in most patients with LVV in clinical remission (41 of 71 [58%]). Clinical disease activity status, disease duration, body mass index, and glucocorticoid use were independently associated with activity on PET scan. Among patients who underwent PET during clinical remission, future clinical relapse was more common in patients with a high PETVAS than in those with a low PETVAS (55% versus 11%; P = 0.03) over a median follow-up period of 15 months. CONCLUSION FDG-PET provides information about vascular inflammation that is complementary to, and distinct from, clinical assessment in LVV. FDG-PET scan activity during clinical remission was associated with future clinical relapse.
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Affiliation(s)
- Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Sara Alehashemi
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Armin A Bagheri
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | - Mariana J Kaplan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | - Elaine Novakovich
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | - Mark A Ahlman
- Radiology and Imaging Sciences, NIH, Bethesda, Maryland
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Ponte C, Águeda A, Luqmani R. Clinical features and structured clinical evaluation of vasculitis. Best Pract Res Clin Rheumatol 2018; 32:31-51. [DOI: 10.1016/j.berh.2018.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/14/2018] [Indexed: 10/27/2022]
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Barra L, Kanji T, Malette J, Pagnoux C. Imaging modalities for the diagnosis and disease activity assessment of Takayasu's arteritis: A systematic review and meta-analysis. Autoimmun Rev 2018; 17:175-187. [DOI: 10.1016/j.autrev.2017.11.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Zhang X, Zhou J, Sun Y, Shi H, Ji Z, Jiang L. 18F-FDG-PET/CT: an accurate method to assess the activity of Takayasu’s arteritis. Clin Rheumatol 2018; 37:1927-1935. [DOI: 10.1007/s10067-017-3960-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/19/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
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An YS, Suh CH, Jung JY, Cho H, Kim HA. The role of 18F-fluorodeoxyglucose positron emission tomography in the assessment of disease activity of adult-onset Still's disease. Korean J Intern Med 2017; 32:1082-1089. [PMID: 27926812 PMCID: PMC5668387 DOI: 10.3904/kjim.2015.322] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/13/2015] [Accepted: 11/23/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been suggested as a reliable imaging technique for monitoring of disease activity in patients with adult-onset Still's disease (AOSD). Therefore, we investigated the clinical significance of 18F-FDG PET/CT in Korean AOSD patients. METHODS Thirteen AOSD patients were included in the study. The PET/CT images were evaluated with visual and semiquantitative method using standardized uptake values (SUVs). RESULTS The presence of increased 18F-FDG uptake was noted in 90% of clinically active AOSD patients. 18F-FDG uptake was located in the lymph node, spleen, and bone marrow. Visual grade and SUV intensity of lymph node was significantly correlated with the systemic score of AOSD. Visual grade of spleen was significantly correlated with the systemic score, erythrocyte sedimentation rate (ESR), and ferritin. Additionally, visual grade and SUV intensity of bone marrow was significantly correlated with the systemic score, ESR, leukocyte, and neutrophil. CONCLUSIONS Visual grade and SUV intensity of lymph node, spleen, and bone marrow on 18F-FDG PET/CT scan showed significant correlations with known disease activity markers. The data suggest that 18F-FDG PET/CT scan may be a useful imaging technique for evaluation of disease activity in AOSD patients.
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Affiliation(s)
- Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hundo Cho
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
- Correspondence to Hyoun-Ah Kim, M.D. Department of Rheumatology, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5151 Fax: +82-31-219-5154 E-mail:
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Youngstein T, Tombetti E, Mukherjee J, Barwick TD, Al-Nahhas A, Humphreys E, Nash J, Andrews J, Incerti E, Tombolini E, Salerno A, Sartorelli S, Ramirez GA, Papa M, Sabbadini MG, Gianolli L, De Cobelli F, Fallanca F, Baldissera E, Manfredi AA, Picchio M, Mason JC. FDG Uptake by Prosthetic Arterial Grafts in Large Vessel Vasculitis Is Not Specific for Active Disease. JACC Cardiovasc Imaging 2017; 10:1042-1052. [DOI: 10.1016/j.jcmg.2016.09.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/02/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
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Gomez L, Chaumet-Riffaud P, Noel N, Lambotte O, Goujard C, Durand E, Besson FL. Effect of CRP value on 18F-FDG PET vascular positivity in Takayasu arteritis: a systematic review and per-patient based meta-analysis. Eur J Nucl Med Mol Imaging 2017; 45:575-581. [PMID: 28856429 DOI: 10.1007/s00259-017-3798-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/03/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to quantify the association between the CRP value and 18F-FDG PET vascular positivity in Takayasu arteritis (TAK) through a structured dedicated systematic review and meta-analysis. METHODS From January 2000 to December 2016, the PubMed/MEDLINE database was searched for articles specifically dealing with the assessment of vascular inflammation using 18F-FDG PET and CRP biomarkers in TAK. Inclusion criteria for the qualitative analysis were (1) 18F-FDG PET used to assess the disease activity, (2) The use of the ACR criteria for the diagnosis of TAK, (3) No case mixed vasculitis (i.e., no giant cell arteritis), and (4) CRP concentration and clinical disease activity available. For the meta-analysis, PET-positive and PET-negative subgroups with the corresponding CRP concentrations were generated based on per patient data. The standard mean difference, which represents the effect of the CRP concentrations on the 18F-FDG PET vascular uptake, was computed for all studies, and then the results were pooled together. RESULTS Among the 33 initial citations, nine complete articles including 210 patients fulfilled the inclusion criteria. Five studies found a significant correlation between the 18F-FDG PET and CRP concentration, one provided a trend towards association and three did not find any association between the two biomarkers. Six studies found a significant association between 18F-FDG PET and clinical disease activity, one found a trend towards association and the last two studies did not evaluate this correlation. The meta-analysis (121 patients) provided the following results: Standard Mean Deviation = 0.54 [0.15;0.92]; Chi2 = 3.35; I2 = 0%; Test for overall effect: Z = 2.70 (P = 0.007). CONCLUSION The CRP concentration only moderately reflects the 18F-FDG PET vascular positivity in TAK, suggesting dissociated information. Standardized longitudinal prospective studies are necessary to assess the value of 18F-FDG PET as an independent biomarker for subtle vascular wall inflammation detection.
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Affiliation(s)
- Léa Gomez
- Department of Biophysics and Nuclear Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France
| | - Philippe Chaumet-Riffaud
- Department of Biophysics and Nuclear Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France
| | - Nicolas Noel
- Department of Internal Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- INSERM UMR 1184, Immunologie des Maladies Virales et Autoimmunes (IMVA), Université Paris Sud, Le Kremlin Bicêtre, France
- CEA, DSV/iMETI, Division of Immuno-Virology IDMIT, Paris, France
| | - Olivier Lambotte
- Department of Internal Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- INSERM UMR 1184, Immunologie des Maladies Virales et Autoimmunes (IMVA), Université Paris Sud, Le Kremlin Bicêtre, France
- CEA, DSV/iMETI, Division of Immuno-Virology IDMIT, Paris, France
| | - Cécile Goujard
- Department of Internal Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- CEA, DSV/iMETI, Division of Immuno-Virology IDMIT, Paris, France
- INSERM U1018, CESP, Le Kremlin Bicêtre, France
| | - Emmanuel Durand
- Department of Biophysics and Nuclear Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- IR4M - UMR8081, Université Paris Sud, Université Paris Saclay, CNRS, 91404, Orsay, France
| | - Florent L Besson
- Department of Biophysics and Nuclear Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.
- Université Paris Sud, Le Kremlin Bicêtre, France.
- IR4M - UMR8081, Université Paris Sud, Université Paris Saclay, CNRS, 91404, Orsay, France.
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Tombetti E, Mason JC. Application of imaging techniques for Takayasu arteritis. Presse Med 2017; 46:e215-e223. [PMID: 28757178 DOI: 10.1016/j.lpm.2017.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/07/2017] [Indexed: 11/26/2022] Open
Abstract
Arterial injury with subsequent remodelling and predisposition to arterial stenosis and/or dilation are the hallmarks of Takayasu arteritis. The degree of arterial damage closely aligns with prognosis and therefore its prevention is the predominant aim of therapy. Non-invasive imaging has greatly improved our ability to identify the extent and severity of disease and to monitor its progress. However, many questions remain concerning the optimal use of individual modalities at different stages of disease. Imaging methods for the quantification of arterial damage are lacking. Likewise, no single technique can accurately determine disease activity within the arterial wall or distinguish inflammatory and non-inflammatory disease progression. The aim of this review is to outline current imaging strategies in Takayasu arteritis, their individual roles in diagnosis and disease monitoring and potential future advances.
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Affiliation(s)
- Enrico Tombetti
- San Raffaele Scientific Institute, Department of Immunology, Transplantation and Infectious Diseases, Milano, Italy.
| | - Justin C Mason
- Hammersmith Hospital, Imperial College London, Rheumatology and Vascular Science, London, UK
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Okazaki T, Shinagawa S, Mikage H. Vasculitis syndrome-diagnosis and therapy. J Gen Fam Med 2017; 18:72-78. [PMID: 29263994 PMCID: PMC5689388 DOI: 10.1002/jgf2.4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 10/05/2015] [Indexed: 01/25/2023] Open
Abstract
In patients with connective tissue disease, vascular injury induced by primary or secondary vasculitis syndromes can lead to organ dysfunction due to the loss of nutrient supply from the blood. Such vasculitis syndromes can be refractory to treatment and fatal. The nomenclature and the definition of vasculitis syndromes have recently been revised, and clinical practice guidelines for diseases associated with vasculitis syndrome are evolving. The present review provides an overview of vasculitis syndromes from the viewpoint of diagnosis and treatment.
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Affiliation(s)
- Takahiro Okazaki
- Division of Rheumatology and Allergology Department of Internal Medicine St. Marianna University School of Medicine Miyamae-ku, Kawasaki Japan
| | - Shoshi Shinagawa
- Division of Rheumatology and Allergology Department of Internal Medicine St. Marianna University School of Medicine Miyamae-ku, Kawasaki Japan
| | - Hidenori Mikage
- Division of Rheumatology and Allergology Department of Internal Medicine St. Marianna University School of Medicine Miyamae-ku, Kawasaki Japan
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18F-FDG PET reveals unique features of large vessel inflammation in patients with Takayasu’s arteritis. Eur J Nucl Med Mol Imaging 2017; 44:1109-1118. [DOI: 10.1007/s00259-017-3639-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/25/2017] [Indexed: 12/14/2022]
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Lee KW, Lee ST, Cho H. Posterior reversible encephalopathy syndrome caused by presumed Takayasu arteritis. KOREAN JOURNAL OF PEDIATRICS 2016; 59:S145-S148. [PMID: 28018468 PMCID: PMC5177699 DOI: 10.3345/kjp.2016.59.11.s145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/03/2015] [Accepted: 03/17/2015] [Indexed: 11/27/2022]
Abstract
Takayasu arteritis (TA) is a chronic inflammatory disease of unknown etiology that affects mainly the aorta, main aortic branches, and pulmonary arteries. Diverse neurological manifestations of TA have rarely been reported in children. Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological condition that presents with headache, seizure, visual disturbances, and characteristic lesions on imaging. Inflammatory condition and severe hypertension in TA can cause PRES. We report of a 5-year-old girl with presumed TA who presented with PRES and chronic total occlusion in the renal artery. The findings on magnetic resonance imaging suggested PRES. Left nephrectomy was performed for total occlusion of the left renal artery, and the confirmatory diagnosis of TA was based on the pathologic findings of the renal artery.
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Affiliation(s)
- Ki Wuk Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Taek Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Germanò G, Macchioni P, Possemato N, Boiardi L, Nicolini A, Casali M, Versari A, Pipitone N, Salvarani C. Contrast-Enhanced Ultrasound of the Carotid Artery in Patients With Large Vessel Vasculitis: Correlation With Positron Emission Tomography Findings. Arthritis Care Res (Hoboken) 2016; 69:143-149. [DOI: 10.1002/acr.22906] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/08/2016] [Accepted: 03/29/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Luigi Boiardi
- Azienda Ospedaliera IRCCS di Reggio Emilia; Reggio Emilia Italy
| | | | | | | | - Nicolò Pipitone
- Azienda Ospedaliera IRCCS di Reggio Emilia; Reggio Emilia Italy
| | - Carlo Salvarani
- Azienda Ospedaliera IRCCS di Reggio Emilia; Reggio Emilia Italy
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Abstract
Various imaging modalities, including color duplex ultrasonography, CT angiography, magnetic resonance angiography, and PET, are emerging as important aids to the diagnosis, staging, evaluation of disease activity and response to treatment in systemic vasculitis. Although large-vessel vasculitis is the main target of imaging, refinement and increasing accuracy of imaging modalities are also providing useful information in the evaluation of medium-vessel and small-vessel vasculitis.
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18F-FDG uptake in main arterial branches of patients with large vessel vasculitis: visual and semiquantitative analysis. Ann Nucl Med 2016; 30:409-20. [PMID: 27068039 DOI: 10.1007/s12149-016-1075-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Over the last decade, the contribution of (18)F-FDG (FDG) PET/CT imaging to the diagnosis of large vessel vasculitis has been widely investigated. The aim of this study was to evaluate a more extensive role for PET/CT in grading vascular inflammation in patients with different clinical stages of disease. METHODS The images of 66 PET/CT studies of 34 patients, performed at diagnosis and/or during follow-up were reviewed. FDG uptake in different regions of aorta and in its major branches was visually (regional Score: rS) and semiquantitatively (regional SUVmean: rSUV) assessed. The global vascular uptake was also evaluated for each study by summing all rSs (summed Score; sS) and averaging rSUVs (averaged SUV; aSUV). FDG uptake in 15 PET/CT studies of control age-matched subjects without signs or symptoms of vasculitis was also analyzed. RESULTS Higher levels of regional and global FDG uptake were found at diagnosis in comparison with follow-up studies of 12 patients with complete longitudinal observation (p value range 0.0552-0.0026). In the latter group high values were generally observed when disease relapse or incomplete response to therapy (active disease) occurred, whereas lower uptake was found in studies of remitted patients (p = <0.01), whose FDG levels were similar to those of control subjects. At ROC analysis performed on all image dataset, optimal cut-off levels of regional and global FDG vascular uptake provided a good discrimination between 25 patients at diagnosis and 15 control subjects (aSUV greater than 0.697; PPV = 92.3; NPV = 92.9). Major overlap was observed among FDG levels of 21 patients with active disease and in remission (aSUV greater than 0.653; PPV = 58.3; NPV = 94.1). Similar performances of visual and semiquantitative analyses were found when areas under curves (AUCs) were compared. CONCLUSIONS (18)F-FDG PET/CT has a promising role in grading inflammation in patients with large arteries vasculitis. Nevertheless, a cut-off based analysis of FDG vascular uptake is not sufficient to separate patients with active and inactive disease during follow-up.
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41
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Mekinian A, Djelbani S, Viry F, Fain O, Soussan M. Place de l’imagerie dans l’évaluation des vascularites de gros vaisseaux. Rev Med Interne 2016; 37:245-55. [DOI: 10.1016/j.revmed.2015.10.353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/08/2015] [Accepted: 10/27/2015] [Indexed: 12/13/2022]
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An J, Yu Y, Lee S, Lee H, Choi BY. Successful Infliximab Therapy in a Patient with Refractory Takayasu's Arteritis. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.1.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jinyoung An
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Yeonsil Yu
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Suhyeon Lee
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Hyunsuk Lee
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Byoong Yong Choi
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
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Perez-Alamino R, Maldonado-Ficco H. New insights on biomarkers in systemic vasculitis. Curr Rheumatol Rep 2015; 17:12. [PMID: 25740705 DOI: 10.1007/s11926-015-0497-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The systemic vasculitis is a heterogeneous group of diseases characterized by the inflammation of blood vessels. The development of advanced diagnostic tests and genetic studies have resulted in greater improvement in our understanding of vasculitis pathogenesis and thus in the development of newer therapies. However, there is still an unmet need in the management of systemic vasculitis, focused on developing of new biomarkers that would enable distinction between active disease from damage or infection and predict treatment response and prognosis.
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Affiliation(s)
- Rodolfo Perez-Alamino
- Rheumatology Section, Hospital Nicolás Avellaneda, 2000 Catamarca Street, Tucumán, Argentina,
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44
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Nakagomi D, Jayne D. Outcome assessment in Takayasu arteritis. Rheumatology (Oxford) 2015; 55:1159-71. [PMID: 26472566 DOI: 10.1093/rheumatology/kev366] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Indexed: 01/24/2023] Open
Abstract
Takayasu arteritis (TAK) is a systemic granulomatous large-vessel vasculitis with a phenotype that overlaps with GCA and defined by the 1993 and 2012 Chapel Hill Consensus Conference statements. However, the diagnosis of TAK is often delayed since TAK patients may be asymptomatic or have non-specific symptoms. Once a diagnosis is made, it is difficult to judge remission or recurrence since there are no reliable assessment tools. With the availability of newer agents, such as cytokine blockade, which are being evaluated in GCA, there is the potential for real advances in TAK patient management. Without reliable assessment tools it will be difficult to introduce newer agents in an organized way or to optimally benefit patients in the future. In this article we review the use and performance of disease indicators in TAK clinical trials as a basis for the further development of assessment tools for this disease.
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Affiliation(s)
- Daiki Nakagomi
- Lupus and Vasculitis Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - David Jayne
- Lupus and Vasculitis Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
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(18)F-Fluorodeoxyglucose positron emission tomography and serum cytokines and matrix metalloproteinases in the assessment of disease activity in Takayasu's arteritis. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 56:299-308. [PMID: 27476622 DOI: 10.1016/j.rbre.2015.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 03/01/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate (18)F-fluorodeoxyglucose ((18)F-FDG) uptake on positron emission tomography-computed tomography (PET-CT) and serum levels of different cytokines and matrix metalloproteinases (MMPs) in patients with Takayasu arteritis (TA) and associations with disease activity. METHODS Serum levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-2, IL-6, IL-8, IL-12, IL-18, MMP-3 and MMP-9 were measured in 36 TA patients and 36 controls. Maximum standard uptake value (SUVmax) of (18)F-FDG in arterial walls was determined by PET-CT scans. TA patients were classified as active disease, inactive disease and possible active disease. RESULTS Serum IL-6 and MMP-3 levels were higher in TA patients than in controls (p<0.001). Serum IL-6 was higher in patients with active disease and in patients with possible active disease than in inactive disease (p<0.0001). Patients with active disease had higher serum TNFα levels than patients with inactive disease (p=0.049) while patients with possible active disease presented higher IL-18 levels than patients with inactive disease (p=0.046). Patients with active disease had higher SUVmax values than those with inactive disease (p=0.042). By receiver operating characteristic (ROC) curve SUVmax was predictive of active disease in TA and values ≥1.3 were associated with disease activity (p=0.039). Serum TNF-α levels were higher in patients with SUVmax≥1.3 than <1.3 (p=0.045) and controls (p=0.012). Serum IL-6 levels were higher in patients with SUVmax≥1.3 than in controls (p<0.001). No differences regarding other biomarkers were found between TA patients and controls. CONCLUSIONS Higher serum IL-6 and TNFα levels as well as higher (18)F-FDG uptake in arterial wall are associated with active TA.
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Abstract
PURPOSE OF REVIEW Imaging is becoming a relevant tool for the assessment of patients with systemic vasculitis. This review focuses on recently generated data with potential clinical impact in the diagnosis, evaluation of disease extent and management of systemic vasculitis. RECENT FINDINGS Temporal artery examination by color duplex ultrasonography (CDUS) is a valuable approach to the diagnosis of giant-cell arteritis. Evaluation of additional arteries may increase its diagnostic performance. However, CDUS-specific findings may not be detected in arteries with early inflammation and CDUS-guidance of temporal artery biopsy does not seem to significantly increase its diagnostic yield. Large-vessel involvement detected by computed tomography angiography occurs in two out of three of patients with giant-cell arteritis at diagnosis. Furthermore, significant ascending aortic dilatation can be observed in one out of three of patients after long-term follow-up. Objective cut-offs for detecting large-vessel inflammation by positron emission tomography (PET) are trying to be established through prospective studies. PET may also contribute to the assessment of disease extent in patients with ANCA-associated vasculitis or Behçet's disease. SUMMARY Data generated by existing and emerging imaging techniques are expected to have a major impact in the diagnosis, appraisal of disease extent, evaluation of disease activity and response to treatment in patients with systemic vasculitis.
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Affiliation(s)
- Sergio Prieto-González
- aVasculitis Research Unit, Departments of Systemic Autoimmune Diseases bCenter for Diagnostic Imaging, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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47
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Arraes AED, de Souza AWS, Mariz HA, Silva NP, Torres ICG, Pinto PNV, Lima ENP, Sato EI. [ 18F-Fluorodeoxyglucose positron emission tomography and serum cytokines and matrix metalloproteinases in the assessment of disease activity in Takayasu's arteritis]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 56:S0482-5004(15)00093-5. [PMID: 26304781 DOI: 10.1016/j.rbr.2015.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/05/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To evaluate 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT)-and serum levels of different cytokines and matrix metalloproteinases (MMPs) in patients with Takayasu's arteritis (TA) and associations with disease activity. METHODS Serum levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-2, IL-6, IL-8, IL-12, IL-18, MMP-3 and MMP-9 were measured in 36 TA patients and 36 controls. Maximum standard uptake value (SUVmax) of 18F-FDG in arterial walls was determined by PET-CT scans. TA patients were classified as active disease, inactive disease and possible active disease. RESULTS Serum IL-6 and MMP-3 levels were higher in TA patients than in controls (p<0.001). Serum IL-6 was higher in patients with active disease and in patients with possible active disease than in inactive disease (p<0.0001). Patients with active disease had higher serum TNFα levels than patients with inactive disease (p=0.049) while patients with possible active disease presented higher IL-18 levels than patients with inactive disease (p=0.046). Patients with active disease had higher SUVmax values than those with inactive disease (p=0.042). By ROC curve SUVmax was predictive of active disease in TA and values ≥1.3 were associated with disease activity (p=0.039). Serum TNF-α levels were higher in patients with SUVmax ≥1.3 than<1.3 (p=0.045) and controls (p=0.012). Serum IL-6 levels were higher in patients with SUVmax ≥1.3 than in controls (p<0.001). No differences regarding other biomarkers were found between TA patients and controls. CONCLUSIONS Higher serum IL-6 and TNFα levels as well as higher arterial 18F-FDG uptake are associated with active TA.
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Affiliation(s)
- Anne E D Arraes
- Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Alexandre W S de Souza
- Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Henrique A Mariz
- Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Neusa P Silva
- Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Ivone C G Torres
- Divisão de Radiologia, Hospital A.C. Camargo, São Paulo, SP, Brasil
| | - Paula N V Pinto
- Divisão de Radiologia, Hospital A.C. Camargo, São Paulo, SP, Brasil
| | - Eduardo N P Lima
- Divisão de Radiologia, Hospital A.C. Camargo, São Paulo, SP, Brasil
| | - Emilia I Sato
- Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.
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Danve A, O'Dell J. The Role of 18F Fluorodeoxyglucose Positron Emission Tomography Scanning in the Diagnosis and Management of Systemic Vasculitis. Int J Rheum Dis 2015; 18:714-24. [DOI: 10.1111/1756-185x.12713] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Abhijeet Danve
- Division of Rheumatology; University of Nebraska Medical Center; Omaha Nebraska USA
| | - James O'Dell
- Division of Rheumatology; University of Nebraska Medical Center; Omaha Nebraska USA
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Espígol-Frigolé G, Prieto-González S, Alba MA, Tavera-Bahillo I, García-Martínez A, Gilabert R, Hernández-Rodríguez J, Cid MC. Advances in the diagnosis of large vessel vasculitis. Rheum Dis Clin North Am 2015; 41:125-40, ix. [PMID: 25399944 DOI: 10.1016/j.rdc.2014.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The diagnosis of large-vessel vasculitis has experienced substantial improvement in recent years. While Takayasu arteritis diagnosis relies on imaging, the involvement of epicranial arteries by giant-cell arteritis facilitates histopathological confirmation. When appropriately performed temporal artery biopsy has high sensitivity and specificity. However, an optimal biopsy is not always achievable and, occasionally, the superficial temporal artery may not be involved. Imaging in its various modalities including colour-duplex ultrasonography, computed tomography angiography, magnetic resonance angiography and positron emission tomography, are emerging as important procedures for the diagnosis and assessment of disease extent in large-vessel vasculitis. Recent contributions to the better performance and interpretation of temporal artery biopsies as well as advances in imaging are the focus of the present review.
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Affiliation(s)
- Georgina Espígol-Frigolé
- Vasculitis Research Unit, Department of Systemic Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Systemic Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - Marco A Alba
- Vasculitis Research Unit, Department of Systemic Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - Itziar Tavera-Bahillo
- Vasculitis Research Unit, Department of Systemic Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - Ana García-Martínez
- Vasculitis Research Unit, Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Villarroel 170, Barcelona 08036, Spain
| | - Rosa Gilabert
- Center for Diagnostic Imaging, Hospital Clínic, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Systemic Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - Maria C Cid
- Vasculitis Research Unit, Department of Systemic Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Spain.
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Alibaz-Oner F, Aydin SZ, Akar S, Aksu K, Kamali S, Yucel E, Karadag O, Ozer H, Kiraz S, Onen F, Inanc M, Keser G, Akkoc N, Direskeneli H. Assessment of Patients with Takayasu Arteritis in Routine Practice with Indian Takayasu Clinical Activity Score. J Rheumatol 2015; 42:1443-7. [DOI: 10.3899/jrheum.140817] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/22/2022]
Abstract
Objective.To assess the Indian Takayasu Clinical Activity Score (ITAS2010) in followup of Takayasu arteritis (TA).Methods.ITAS2010 forms were filled in prospectively (n = 144). Clinical activity was assessed with physician’s global assessment (PGA) and criteria defined by Kerr,et al.Results.ITAS2010 was significantly higher in patients with active disease. Total agreement between ITAS2010 and PGA was 66.4%, and between ITAS2010 and Kerr,et alwas 82.8%. During followup, 14 of 15 patients showing vascular progression with imaging were categorized as having inactive disease according to ITAS2010.Conclusion.ITAS2010 was discriminatory for activity during the followup, but the agreement between PGA and ITAS2010 was moderate. Future work should include the incorporation of advanced vascular imaging and demonstration of ITAS2010 as a scalable measure and not simply a dichotomous measure of activity/flare versus remission.
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