A direct comparison in diagnostic performance of CDUS, FDG-PET/CT and MRI in patients suspected of giant cell arteritis

Marieke van Nieuwland; Edgar M Colin; Marloes Vermeer; Nils R L Wagenaar; Onno D Vijlbrief; Jordy K van Zandwijk; Riemer H J A Slart; Hendrik Koffijberg; Erik Groot Jebbink; Kornelis S M van der Geest; Elisabeth Brouwer; Dennis Boumans; Celina Alves

doi:10.1093/rheumatology/keae171

A direct comparison in diagnostic performance of CDUS, FDG-PET/CT and MRI in patients suspected of giant cell arteritis

Rheumatology (Oxford). 2024 Apr 10:keae171. doi: 10.1093/rheumatology/keae171. Online ahead of print.

Affiliations

¹ Department of Rheumatology and Clinical Immunology, Hospital Group Twente (Ziekenhuisgroep Twente), Almelo, the Netherlands.
² ZGT Academy, Hospital Group Twente (Ziekenhuisgroep Twente), Almelo, the Netherlands.
³ Department of Nuclear Medicine, Hospital Group Twente (Ziekenhuisgroep Twente), Almelo, the Netherlands.
⁴ Department of Radiology, Hospital Group Twente (Ziekenhuisgroep Twente), Almelo, the Netherlands.
⁵ Magnetic Detection & Imaging, University of Twente, The Netherlands. Department of Vascular Surgery, Medisch Spectrum Twente, The Netherlands.
⁶ Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands; Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
⁷ Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, The Netherlands.
⁸ Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands.
⁹ Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

PMID: 38597882
DOI: 10.1093/rheumatology/keae171

Abstract

Objectives: This study directly compares diagnostic performance of Colour Duplex Ultrasound (CDUS), Fluor-18-deoxyglucose Positron Emission Tomography Computed Tomography (FDG-PET/CT) and Magnetic Resonance Imaging (MRI) in patients suspected of giant cell arteritis (GCA).

Methods: Patients with suspected GCA were included in a nested-case control pilot study. CDUS, whole body FDG-PET/CT and cranial MRI were performed within 5 working days after initial clinical evaluation. Clinical diagnosis after six months follow-up by experienced rheumatologists in the field of GCA, blinded for imaging, was used as reference standard. Diagnostic performance of the imaging modalities was determined. Stratification for GCA subtype was performed and imaging results were evaluated in different risk stratification groups.

Results: In total, 23 patients with GCA and 19 patients suspected of but not diagnosed with GCA were included. Sensitivity was 69.6% (95%CI 50.4%-88.8%) for CDUS, 52.2% (95%CI 31.4%-73.0%) for FDG-PET/CT and 56.5% (95%CI 35.8%-77.2%) for MRI. Specificity was 100% for CDUS, FDG-PET/CT and MRI. FDG-PET/CT was negative for GCA in all isolated cranial GCA patients (n = 8), while MRI was negative in all isolated extracranial GCA patients (n = 4). In 4 GCA patients with false-negative (n = 2; intermediate and high risk) or inconclusive (n = 2; low and intermediate risk) CDUS results, further imaging confirmed diagnosis.

Conclusions: Sensitivity of CDUS was highest, while specificity was excellent in all imaging modalities. Nevertheless, confidence intervals of all imaging modalities were overlapping. Following EULAR recommendations, CDUS can be used as a first test to diagnose GCA. With insufficient evidence for GCA, further testing considering GCA subtype is warranted.

Keywords: Giant Cell Arteritis; diagnostic imaging; ultrasound; vasculitis.