Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis

K. S. M. van der Geest; G. Treglia; A. W. J. M. Glaudemans; E. Brouwer; M. Sandovici; F. Jamar; O. Gheysens; R. H. J. A. Slart

doi:10.1007/s00259-021-05362-8

Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis

K. S. M. van der Geest^*, G. Treglia, A. W. J. M. Glaudemans, E. Brouwer, M. Sandovici, F. Jamar, O. Gheysens, R. H. J. A. Slart

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

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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.

Original language	English
Pages (from-to)	3886-3902
Number of pages	17
Journal	European Journal of Nuclear Medicine and Molecular Imaging
Volume	48
Issue number	12
Early online date	3-May-2021
DOIs	https://doi.org/10.1007/s00259-021-05362-8
Publication status	Published - Nov-2021

Keywords

Large vessel vasculitis
Giant cell arteritis
Takayasu arteritis
Aortitis
Positron emission tomography computed tomography
Fluorodeoxyglucose F18

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van der Geest, K. S. M., Treglia, G., Glaudemans, A. W. J. M., Brouwer, E., Sandovici, M., Jamar, F., Gheysens, O., & Slart, R. H. J. A. (2021). Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis. European Journal of Nuclear Medicine and Molecular Imaging, 48(12), 3886-3902. https://doi.org/10.1007/s00259-021-05362-8

@article{91e8f9b0dfaf417e8ba004098c2ad057,

title = "Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis",

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.",

keywords = "Large vessel vasculitis, Giant cell arteritis, Takayasu arteritis, Aortitis, Positron emission tomography computed tomography, Fluorodeoxyglucose F18",

author = "{van der Geest}, {K. S. M.} and G. Treglia and Glaudemans, {A. W. J. M.} and E. Brouwer and M. Sandovici and F. Jamar and O. Gheysens and Slart, {R. H. J. A.}",

year = "2021",

month = nov,

doi = "10.1007/s00259-021-05362-8",

language = "English",

volume = "48",

pages = "3886--3902",

journal = "European Journal of Nuclear Medicine and Molecular Imaging",

issn = "1619-7070",

publisher = "Springer",

number = "12",

}

van der Geest, KSM, Treglia, G, Glaudemans, AWJM , Brouwer, E , Sandovici, M, Jamar, F, Gheysens, O & Slart, RHJA 2021, 'Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis', European Journal of Nuclear Medicine and Molecular Imaging, vol. 48, no. 12, pp. 3886-3902. https://doi.org/10.1007/s00259-021-05362-8

Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis. / van der Geest, K. S. M.; Treglia, G.; Glaudemans, A. W. J. M. et al.
In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 48, No. 12, 11.2021, p. 3886-3902.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis

T2 - a systematic review and meta-analysis

AU - van der Geest, K. S. M.

AU - Treglia, G.

AU - Glaudemans, A. W. J. M.

AU - Brouwer, E.

AU - Sandovici, M.

AU - Jamar, F.

AU - Gheysens, O.

AU - Slart, R. H. J. A.

PY - 2021/11

Y1 - 2021/11

N2 - 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.

AB - 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.

KW - Large vessel vasculitis

KW - Giant cell arteritis

KW - Takayasu arteritis

KW - Aortitis

KW - Positron emission tomography computed tomography

KW - Fluorodeoxyglucose F18

U2 - 10.1007/s00259-021-05362-8

DO - 10.1007/s00259-021-05362-8

M3 - Review article

C2 - 33942141

SN - 1619-7070

VL - 48

SP - 3886

EP - 3902

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

IS - 12

ER -

Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis

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