OP0069 THE ROLE OF POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT) IN DISEASE ACTIVITY ASSESSMENT IN PATIENTS WITH LARGE VESSEL VASCULITIS
Authors: E. Galli, F. Muratore, L. Boiardi, M. I. Casali, A. Versari, G. Besutti, L. Spaggiari, P. Mancuso, P. Giorgi Rossi, C. Salvarani
Journal: Annals of the Rheumatic Diseases (2021)

Background: Assessment of disease activity in large vessel vasculitis (LVV) is still an unmet need. PET Vascular Activity Score (PETVAS) is a new composite score aimed at quantifying the overall inflammatory burden by adding together PET qualitative visual scores (0-3, according to Meller) in nine selected arterial regions (1). In two independent cohorts, PETVAS showed to be effective in discriminating between patients with clinically active and inactive vasculitis. Objectives: To assess the role of PET/CT and the performance of PETVAS in differentiating between clinically active and inactive vasculitis in a single center cohort of patients with LVV. Methods: One-hundred patients with radiographic evidence of LVV were enrolled by the Rheumatology Unit of Reggio Emilia Hospital (Italy) between June 2007 and September 2020. All subjects underwent full clinical, laboratory and imaging evaluation (including PET/CT) at baseline, annually and when a relapse was suspected. Medical records of recruited patients were retrospectively reviewed from baseline visit until 30 September 2020, last follow-up or death. For each PET/CT test, the nuclear medicine physician’s interpretation of scans (active/inactive vasculitis) was compared with disease activity clinical judgement (active disease/remission). The latter was based on comprehensive signs/symptoms assessment, laboratory and imaging (excluding PET/CT) data and was considered the reference standard. For each PET/CT scan, PETVAS score was calculated and its performance in discriminating between patients with active and inactive disease was compared to clinical judgement. Results: In the study period 100 LVV patients [51 giant cell arteritis (GCA), 49 Takayasu arteritis (TAK)] underwent a total of 474 PET scans. Nuclear medicine physician’s interpretation of PET/CT was able to discriminate between patients in clinically active LVV (n 167) and those in clinical remission (n 307) with a sensitivity of 60% (95% CI, 51 to 69%) and a specificity of 80% (95% CI, 75 to 84%). The following sensitivity and specificity values were found in LVV subgroups: 73% (95% CI, 59 to 84%) and 77% (95% CI, 70 to 83%) for TAK, and 51% (95% CI, 38 to 63%) and 82% (95% CI, 76 to 88%) for GCA, respectively. LVV patients with higher PETVAS scores were more frequently classified as having active disease: age and sex adjusted OR 1.15 (95% CI, 1.11 to 1.19), p&lt;0.0001. Similar results were found in LVV subgroups, [age and sex adjusted OR 1.12 (95% CI, 1.08 to 1.17) for GCA and 1.22 (95% CI, 1.14 to 1.31) for TAK, all p&lt;0.0001]. The area under receiver operating characteristics (ROC) curve (AUC) of PETVAS in differentiating between clinically active and inactive LVV was 0.73 (95% CI, 0.68 to 0.79). Similar results were found in LVV subgroups, [0.70 (95% CI, 0.62 to 0.78) for GCA, and 0.79 (95% CI, 0.71 to 0.87) for TAK]. A PETVAS ≥10 provided 61% sensitivity and 80% specificity in differentiating between clinically active and inactive LVV (52% sensitivity and 82% specificity in GCA subgroup and 73% sensitivity and 78% specificity in TAK subgroup). Conclusion: In our cohort PET/CT has shown to be useful in monitoring LVV disease activity. PETVAS seems to be a reliable tool in helping clinicians to discriminate between LVV patients with active disease and those in remission. References: [1]Grayson PC, Alehashemi S, Bagheri AA, Civelek AC, Cupps TR, Kaplan MJ, Malayeri AA, Merkel PA, Novakovich E, Bluemke DA, Ahlman MA. 18 F-Fluorodeoxyglucose-Positron Emission Tomography as an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients with Large Vessel Vasculitis. Arthritis Rheumatol. 2018 Mar;70(3):439-449. doi: 10.1002/art.40379. Epub 2018 Feb 6. PMID: 29145713; PMCID: PMC5882488. Disclosure of Interests: None declared