Imaging to predict early relapses after treatment discontinuation in patients with large vessel giant cell arteritis - A cohort study

Andrea K Hemmig; Christof Rottenburger; Luan Baruti; Noemi Mensch; Markus Aschwanden; Diego Kyburz; Maurice Pradella; Daniel Staub; Mihaela Stegert; Christoph T Berger; Stephan Imfeld; Gregor Sommer; Thomas Daikeler

doi:10.1016/j.semarthrit.2024.152425

Imaging to predict early relapses after treatment discontinuation in patients with large vessel giant cell arteritis - A cohort study

Semin Arthritis Rheum. 2024 Feb 28:66:152425. doi: 10.1016/j.semarthrit.2024.152425. Online ahead of print.

Authors

Affiliations

¹ Department of Rheumatology, University Hospital Basel, Basel, Switzerland.
² Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
³ Department of Angiology, University Hospital Basel, Basel, Switzerland.
⁴ Department of Rheumatology, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland.
⁵ Department of Radiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
⁶ Department of Biomedicine, University of Basel, Basel, Switzerland; University Center for Immunology, University Hospital Basel, Basel, Switzerland.
⁷ Institute for Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland.
⁸ Department of Rheumatology, University Hospital Basel, Basel, Switzerland; University Center for Immunology, University Hospital Basel, Basel, Switzerland. Electronic address: Thomas.Daikeler@usb.ch.

PMID: 38442463
DOI: 10.1016/j.semarthrit.2024.152425

Abstract

Objectives: To investigate the value of [¹⁸F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) in predicting relapse after treatment discontinuation in patients with large-vessel giant cell arteritis (LV-GCA).

Methods: This study included patients with LV-GCA whose treatment was discontinued between 2018 and 2023. All patients underwent PET/CT and/or MRI at the time of treatment discontinuation in clinical remission. Qualitative and quantitative PET/CT scores, by measuring standardized uptake values (SUV), and semiquantitative MRI scores of the aorta and supraaortic vessels were compared between patients who relapsed within 4 months after treatment discontinuation and those who did not.

Results: Forty patients were included (median age 67.4 years, interquartile range (IQR) 60.8-74.0; 77.5 % females). Eleven patients (27.5 %) relapsed after treatment discontinuation (time to relapse 1.9 months, IQR 1.4-3.3). Patients who relapsed were comparable to those who remained in remission with respect to the presence of active vasculitis on MRI and/or PET/CT (54.5% vs. 58.6 %, p = 1.0), the number of segments with vasculitic findings on MRI (0, IQR 0.0-1.5, vs. 2, IQR 0.0-3.0, p = 0.221) or the highest SUV artery/liver ratio on PET/CT (1.5, IQR 1.4-1.6, vs. 1.3, IQR 1.2-1.6, p = 0.505). The median number of vasculitic segments on PET/CT was 2.5 (IQR 0.5-4.5) in those with vs. 0 (IQR 0.0-1.5, p = 0.085) in those without relapse, and the PET/CT scores 4.5 (IQR 0.75-8.25) vs. 0 (IQR 0.0-3.0, p = 0.172).

Conclusion: PET/CT or MRI at treatment stop did not predict relapse and may not be suited to guide treatment decisions in patients with LV-GCA in remission.

Keywords: Giant cell arteritis; Magnetic resonance imaging; PET/CT; Vasculitis.