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Introduction <p>FDG-PET/CT offers high diagnostic accuracy in research settings for GCA, a systemic medium-large vessel vasculitis (M-LVV). We aimed to analyse its diagnostic performance in a real-world clinical setting.</p> Methods <p>We audited all patients investigated with FDG-PET/CT for suspected new onset GCA between July 2019 and March 2022, at a single tertiary institution in Australia. Data was collected from patient and physician questionnaires, and scan reports describing FDG activity in cranial, supra-aortic, aortic and infra-aortic vascular territories, and the overall interpretation of the scan. The gold standard comparator in analysis was the unblinded treating physician’s clinical diagnosis at a minimum of 6&#xa0;months after the scan.</p> Results <p>One hundred thirty-five patients had an FDG-PET/CT as part of routine care in the investigation of suspected GCA. Forty-four (32.6%) patients had a clinical diagnosis of M-LVV. Thirty-five (26%) scans were reported as positive, 27 (20%) equivocal and 73 (54%) negative for active M-LVV. Diagnostic performance of FDG-PET/CT was dependent on the treatment of equivocal scans in binary analysis, with sensitivity ranging from 77.3 to 90.9% and specificity ranging from 75.8 to 98.9%. In cases with a clinical diagnosis of M-LVV, the supra-aortic territory was metabolically active in 31 (70.5%) and three had metabolic activity isolated to either the cranial or aortic regions.</p> Conclusions <p>Combined cranial and large vessel FDG-PET/CT shows good diagnostic performance for GCA in a real-world setting. The supra-aortic territory was most commonly active in patients with M-LVV, yet assessment of all territories was required to maximise scan performance.</p> <p><Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> <p><b>Key Points</b></p> <p>• <i>FDG-PET/CT has good diagnostic performance for GCA in the real-world setting.</i></p> <p>• <i>Assessment of both cranial and large vessels is necessary to maximise FDG-PET/CT performance.</i></p> <p>• <i>Equivocal FDG-PET/CT scans (20% of cases) can be further evaluated with ultrasound and/or biopsy.</i></p> </entry> </row> </tbody> </tgroup> </Table></p>

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The real-world experience of combined cranial and large vessel 18F-FDG-PET/CT in the investigation of giant cell arteritis

  • 期刊论文

  • 发表日期：

    2026年1月23日

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  • Keren Port,
  • Ivan Ho Shon,
  • Sally Ayesa,
  • Rachel Langford,
  • Olivia Bennett,
  • Andrew Csillag,
  • Stacey Fredericks,
  • Luz Palacios-Derflingher,
  • Eva A. Wegner,
  • Anthony Sammel

摘要

Introduction

FDG-PET/CT offers high diagnostic accuracy in research settings for GCA, a systemic medium-large vessel vasculitis (M-LVV). We aimed to analyse its diagnostic performance in a real-world clinical setting.

Methods

We audited all patients investigated with FDG-PET/CT for suspected new onset GCA between July 2019 and March 2022, at a single tertiary institution in Australia. Data was collected from patient and physician questionnaires, and scan reports describing FDG activity in cranial, supra-aortic, aortic and infra-aortic vascular territories, and the overall interpretation of the scan. The gold standard comparator in analysis was the unblinded treating physician’s clinical diagnosis at a minimum of 6 months after the scan.

Results

One hundred thirty-five patients had an FDG-PET/CT as part of routine care in the investigation of suspected GCA. Forty-four (32.6%) patients had a clinical diagnosis of M-LVV. Thirty-five (26%) scans were reported as positive, 27 (20%) equivocal and 73 (54%) negative for active M-LVV. Diagnostic performance of FDG-PET/CT was dependent on the treatment of equivocal scans in binary analysis, with sensitivity ranging from 77.3 to 90.9% and specificity ranging from 75.8 to 98.9%. In cases with a clinical diagnosis of M-LVV, the supra-aortic territory was metabolically active in 31 (70.5%) and three had metabolic activity isolated to either the cranial or aortic regions.

Conclusions

Combined cranial and large vessel FDG-PET/CT shows good diagnostic performance for GCA in a real-world setting. The supra-aortic territory was most commonly active in patients with M-LVV, yet assessment of all territories was required to maximise scan performance.

Key Points

• FDG-PET/CT has good diagnostic performance for GCA in the real-world setting.

• Assessment of both cranial and large vessels is necessary to maximise FDG-PET/CT performance.

• Equivocal FDG-PET/CT scans (20% of cases) can be further evaluated with ultrasound and/or biopsy.