Learn about assessing disease activity in large vessel vasculitis using new imaging techniques. Dr. Kaitlin Quinn discusses her study on the association between PET activity and angiographic changes in patients with large vessel vasculitis. The podcast also covers patient recruitment, imaging protocols, limitations of imaging vasculitis, collaboration between Duke University and the NIH, and the diverse range of patients in rheumatology.
A negative PET scan in large vessel vasculitis indicates stable angiographic disease.
The presence of PET activity is strongly associated with subsequent angiographic change, emphasizing the benefits of frequent imaging to monitor disease progression.
Deep dives
Assessing Disease Activity in Large Vessel Vasculitis
Assessing disease activity in large vessel vasculitis, especially as imaging techniques evolve, presents a challenge for clinicians. This study focused on the association between 18F Florodioxyglucose Positron Emission Tomography (PET) activity and angiographic progression of disease in large vessel vasculitis. The findings revealed that a negative PET scan provided reassurance as it indicated stable angiographic disease. Furthermore, the presence of PET activity was strongly associated with subsequent angiographic change, highlighting the potential benefits of frequent imaging to monitor disease progression. The study also emphasized the importance of multimodal imaging and incorporating different forms of imaging to better assess and predict disease outcomes.
Patient Cohort and Imaging Protocol
The study cohort consisted of 70 patients with large vessel vasculitis, half of whom had takayasu arteritis and the other half had giant cell arthritis. The patients underwent whole-body PET scans and angiography (MRA or CTA) at the NIH Clinical Center. The analysis included qualitative and semi-quantitative measures of PET activity and assessment of vascular wall morphology changes on angiograms. The study found that patients with takayasu arteritis and active clinical disease were more likely to develop new or worsening vascular damage. Territorial matching analysis within patients revealed that baseline PET activity was a strong predictor of subsequent angiographic progression in specific arterial territories.
Implications and Recommendations for Clinical Practice
The study provided valuable insights into disease monitoring and management in large vessel vasculitis. While a negative PET scan was reassuring, clinicians should consider the specific subtype of vasculitis and the presence of clinical symptoms when interpreting the results. Frequent imaging, especially for patients with takayasu arteritis, can be helpful in assessing disease progression and making treatment decisions. The study also highlighted the importance of multimodal imaging, combining PET scans with MRA or CTA, to better evaluate disease activity and predict outcomes. Overall, the research presented a compelling case for incorporating PET imaging into clinical practice for monitoring large vessel vasculitis.
Assessing disease activity in large vessel vasculitis can be a challenge. And as imaging techniques evolve, clinicians must evaluate how to harness new imaging modalities in clinical care. In an attempt to predict the progression of large vessel vasculitis (LVV), our next guest, Dr. Kaitlin Quinn, used the vascular activity seen on a fluorodeoxyglucose-positron emission tomography (FDG-PET) scan to determine if there is an observable association with angiographic change. Dr. Quinn, author of the study Association of 18F-Fluorodeoxyglucose–Positron Emission Tomography Activity With Angiographic Progression of Disease in Large Vessel Vasculitis, breaks down her study and its methods along with her observations and findings for us.
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