^(18)F-FDG PET/CT对大动脉炎活动性的评估价值

Value of ^(18)F-FDG PET/CT in evaluating the activity of Takayasu arteritis

目的探讨^(18)F-FDG PET/CT对大动脉炎(TA)疾病活动性定性评估的价值以及PET血管活性评分(PETVAS)与疾病活动性的关系。方法采用回顾性研究方法,纳入2016年2月至2021年8月郑州大学第一附属医院的TA患者84例[男12例、女72例,年龄(30.0±7.3)岁],根据Kerr评分将患者分为临床活动性组(68例)和非活动性组(16例)。患者均行^(18)F-FDG PET/CT显像,依据视觉评分对PET/CT图像进行定性判读(活动/非活动性)并获得PETVAS。采用Mann-WhitneyU检验比较2组间PETVAS及炎性反应指标[血红细胞沉降率(ESR)和C反应蛋白(CRP)],采用Spearman秩相关评价PETVAS、Kerr评分、ESR、CRP之间的相关性,采用ROC曲线分析比较PETVAS与ESR、CRP对TA疾病活动性的评估效能。结果以PET/CT图像视觉评分(≥2分)判断TA疾病活动性的灵敏度、特异性、准确性分别为86.8%(59/68)、15/16、88.1%(74/84);临床活动性组PETVAS(分)、ESR(mm/1 h)、CRP(mg/L)均明显高于临床非活动性组[11.0(6.0,18.0)与0.0(0.0,3.0)、67.0(25.3,104.0)与10.1(7.1,20.8)和32.3(7.1,72.1)与1.8(1.0,5.3);z值:4.53~5.23,均P<0.001];PETVAS与Kerr评分、ESR和CRP均呈正相关(rs值:0.65、0.57和0.56,均P<0.001),Kerr评分与PETVAS的相关性高于其与CRP和ESR的相关性(rs值:0.55和0.55,均P<0.001);PETVAS的ROC AUC和约登指数(YI)分别为0.92和0.77,高于CRP(AUC=0.87,YI=0.65)和ESR(AUC=0.87,YI=0.66)。结论^(18)F-FDG PET/CT是定性评估TA患者疾病活动性的有效工具,PETVAS有助于判断TA疾病活动性,其效能优于炎性指标。

Objective To investigate the value of ^(18)F-FDG PET/CT in qualitative evaluation of disease activity in patients with Takayasu arteritis(TA),and discuss the relationship between PET vascular activity score(PETVAS)and disease activity.Methods A total of 84 patients(12 males,72 females,age:(30.0±7.3)years)with TA,who underwent ^(18)F-FDG PET/CT imaging in the First Affiliated Hospital of Zhengzhou University between February 2016 and August 2021,were retrospectively reviewed.All patients were divided into active(n=68)and inactive groups(n=16)according to Kerr score.PET/CT images were semiquantitatively evaluated according to the visual score and PETVAS was calculated.Mann-Whitney U test was used to compare the differences of PETVAS and inflammatory indexes(erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP))between two groups.Spearman rank correlation analysis was used to evaluate the relationships among PETVAS,Kerr score and inflammatory indexes.ROC curve analysis was employed to compare the diagnostic efficiencies of PETVAS,ESR and CRP for disease activity.Results The sensitivity,specificity and accuracy of ^(18)F-FDG PET/CT in evaluating the activity of TA by visual score(≥2)were 86.8%(59/68),15/16 and 88.1%(74/84),respectively.PETVAS,ESR(mm/1 h)and CRP(mg/L)in active group were higher than those in inactive group(11.0(6.0,18.0)vs 0.0(0.0,3.0),67.0(25.3,104.0)vs 10.1(7.1,20.8)and 32.3(7.1,72.1)vs 1.8(1.0,5.3),respectively;z values:4.53-5.23,all P<0.001).PETVAS was positively correlated with Kerr score(rs=0.65,P<0.001),ESR(rs=0.57,P<0.001)and CRP(rs=0.56,P<0.001).The correlation coefficient between Kerr score and PETVAS was higher than that between Kerr score and CRP(rs=0.55,P<0.001)and ESR(rs=0.55,P<0.001).ROC AUC and Youden Index(YI)of PETVAS(AUC=0.92,YI=0.77)were higher than those of CRP(AUC=0.87,YI=0.65)and ESR(AUC=0.87,YI=0.66).Conclusions ^(18)F-FDG PET/CT is an effective tool for qualitative evaluation of TA disease activity.PETVAS is helpful in evaluating disease activity of TA,with a better efficacy than inflammatory indexes.