Direct Comparison of the Diagnostic Accuracy of PET/CT, Cranial MRI, Ultrasound and Temporal Artery Biopsy in Giant Cell Arteritis

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2025 Feb 25

PMID 40000462

Authors

Lien Moreel

Albrecht Betrains

Lennert Boeckxstaens

Griet Pieters

Els Wuyts

Birgit Weynand

Inge Fourneau

Koen Van Laere

Philippe Demaerel

Ellen De Langhe

Steven Vanderschueren

Daniel Blockmans

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the diagnostic accuracy of PET/CT, cranial MRI, ultrasound and temporal artery biopsy (TAB) in patients with suspected giant cell arteritis (GCA) in a direct comparison.

Methods: Consecutive patients with a suspicion of GCA and at least 2 diagnostic tests ≤ 7 days after initiation of glucocorticoids between June 2021 and June 2024, were included retrospectively. The gold standard for the diagnosis of GCA was the judgment of experienced clinicians after a follow-up of ≥ 6 months. Examinations were compared within subgroups undergoing the same tests.

Results: Sixty-one GCA patients and 50 patients with an alternative diagnosis were included. Combined cranial and large vessel PET/CT had the highest sensitivity (89% [95%CI 77-96%]) and specificity (98% [95%CI 88-100%]). Cranial PET/CT and TAB yielded a better sensitivity compared to temporal artery ultrasound (83% [95%CI 64-94%], 77% [95%CI 59-90%] and 55% [95%CI 36-74%], respectively, p = 0.023) without difference in specificity (100% [95%CI 100 - 84%], 95% [95%CI 76-100%] and 81% [95%CI 58-95%], respectively, p = 0.136). Cranial MRI had a sensitivity of 56% (95%CI 21-86%) and specificity of 82% (95%CI 48-98%). Large vessel PET/CT resulted in a better sensitivity compared to axillary artery ultrasound (68% [95%CI 45-86%] vs. 18% [95%CI 5-40%], p = 0.001) without difference in specificity (100% [95% CI 82-100%] vs. 90% [95%CI 67-99%], p = 0.50).

Conclusion: PET/CT had a better sensitivity than ultrasound and cranial MRI. TAB and cranial PET/CT had a similar diagnostic yield.

Clinical Trial Number: Not applicable.

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