AB1224 Ct pet scans in suspected large vessel vasculitis and giant cell arteritis – an audit in the belfast health and social care trust (BHSCT)
Authors: U.A. Laverty, E. Banks, M. McHenry
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> British Society of Rheumatology (BSR) guidelines, due to be updated in April 2018, recommend consideration of CT PET when there is suspicion of large-vessel GCA (LV-GCA) in patients with prominent systemic symptoms, limb claudication or persistently high-inflammatory markers despite adequate glucocorticosteroid therapy. Vascular Ultrasound is unhelpful in assessment of the aorta. <h3>Objectives</h3> We investigated the use of CT PET in suspected cases of LV-GCA and its impact on management of patients in the BHSCT from August 2016 to August 2017. <h3>Methods</h3> The IT support team in Royal Victoria Hospital provided a list of CTPET scans requested under the specific code for vasculitis and/or Pyrexia/infection and another code for general. Of the 250 scans identified under these codes, 34 scans were requested by Rheumatology for possible vasculitis following a review of the electronic care records. A proforma was used to aid data collection. <h3>Results</h3> Female:Male ratio was 3.25:1, with a mean age of 65. 88% of the scans were requested due to a suspected diagnosis of vasculitis and 12% were for follow up of known vasculitis. 24% of CT PET scans were positive for large vessel vasculitis (LVV). The ESR was greater than 50 mm/hr in 75% of positive scans. Of those patients with a positive CT PET scan, 88% were treated with steroids. Of those patients with a negative CT PET scan, 42% were treated with steroids. It is noteworthy that 29% of patients were on steroids at the time of CT PET which may impact results. 60% of patients who were on steroids at the time of CT PET were on 60 mg of prednisolone daily. 31% of patients with negative scans were on steroids at the time of CT PET. 46% of patients with negative CT PET scans remained on steroid treatment. Steroid treatment was continued in patients with negative scans on basis of active aortic valve histology ±clinical criteria for diagnosis of GCA ±cerebral vasculitis on neuroimaging ±polymyalgia rheumatica evident on CTPET. CT PET changed management in 65% of patients with positive results supporting steroid treatment and negative results guiding withdrawal of steroids. <h3>Conclusions</h3> We are fortunate to have access to CT PET in Northern Ireland. CT PET scans changed management in 65% of our patients, despite 29% of patients being on steroid treatment prior to CT PET. We wish to increase awareness of the role CTPET in the diagnosis and management of LVV. We are liaising with radiology colleagues to refine and maximise appropriate referrals for CT PET scans for patients with suspected vasculitis. <h3>References</h3> [1] BSR and BHPR guidelines for the management of giant cell arteritis. Bhaskar Dasgupta, et al. Rheumatology, Volume 49, Issue 8, 1 August 2010, Pages1594–1597, Published: 05 April 2010 [2] EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Christian Dejaco, et al. Ann Rheum Dispublished online January 22, 2018 <h3>Disclosure of Interest</h3> None declared