PET-CT诊断颞动脉炎有很高的敏感性和特异性

摘要：背景:正电子发射断层显像(PET)扫描是新兴的有前途的影像技术，可以检测巨细胞动脉炎（GCA）的大血管炎症。然而，缺乏基于氟脱氧葡萄糖（FDG）摄取的标准化血管炎定义，是将PET扫描用于诊断目的的重要限制因素。

目的:前瞻性评估与对照组相比，新近诊断的巨细胞动脉炎患者不同血管区域的FDG摄取的强度及分布。

方法:纳入32名活检证实糖皮质激素治疗≤3天的患者。对照组由20名用PET/CT行肿瘤分期者组成。 在主动脉的4个节段、主动脉上分支和髂股动脉区域计算最大标准化摄取值(SUVm)。使用受试者工作特征曲线（ROC）曲线分析计算灵敏度和特异度。

结果:血管炎组所有检测的血管平均SUVm值显著高于对照组，且与急性时相蛋白和血IL-6相关。所有血管区域的平均SUVm值为0.830，截点值1.89诊断巨细胞动脉炎的灵敏度为80%，特异度为79%。检测的血管床之间的AUC值无显著差异。

结论: 大血管的FDG摄取诊断巨细胞动脉炎有很高的灵敏度和特异度。

附原文：Abstract BACKGROUND:Positron emission tomography (PET) scan is emerging as a promising imaging technique to detect large-vessel inflammation in giant cell arteritis (GCA). However, the lack of a standardised definition of arteritis based on 18fluorodeoxyglucose (FDG) uptake is an important limitation to the use of PET scan for diagnostic purposes. OBJECTIVE:To prospectively assess the intensity and distribution of FDG uptake at different vascular territories in patients with newly diagnosed GCA compared with controls. METHODS: 32 consecutive, biopsy-proven, GCA patients treated with glucocorticoids for ≤3 days were included. The control group consisted of 20 individuals, who underwent PET/CT for cancer staging. Maximal standardised uptake value (SUVm) was calculated at four aortic segments, supraaortic branches and iliac-femoral territory. Sensitivity and specificity was calculated by receiver-operator characteristic curves (ROC) analysis. RESULTS: Mean SUVm was significantly higher in patients than in controls in all vessels explored and correlated with acute-phase reactants and serum IL-6. Mean of the SUVm at all the vascular territories had an area under the curve (AUC) of 0.830, and a cut-off of 1.89 yielded a sensitivity of 80% and a specificity of 79% for GCA diagnosis. There were no significant differences in AUC among the vascular beds examined. CONCLUSIONS: FDG uptake by large vessels has a substantial sensitivity and specificity for GCA diagnosis.

引自：Prieto-González S1, Depetris M, García-Martínez A, Espígol-Frigolé G, Tavera-Bahillo I, Corbera-Bellata M, Planas-Rigol E, Alba MA, Hernández-Rodríguez J, Grau JM, Lome?a F, Cid MC.Positron emission tomography assessment of large vessel inflammation in patients with newly diagnosed, biopsy-proven giant cell arteritis: a prospective, case-control study. Ann Rheum Dis. 2014 Mar 24. doi: 10.1136/annrheumdis-2013-204572. [Epub ahead of print]