Performance of the PET vascular activity score (PETVAS) for qualitative and quantitative assessment of inflammatory activity in Takayasu's arteritis patients

PURPOSE To assess the performance of PET vascular activity score (PETVAS) in comparison with SUVmax, inflammatory biomarkers and ITAS-2010 score in a cohort of TAK patients.
METHODS Sixty-four PET/CT scans acquired from 54 TAK patients were analyzed. The inflammatory activity was qualitatively determined by physician's global assessment and quantitatively determined by ITAS-2010 score. SUVmax and PETVAS were acquired by consensus review. Levels of the inflammatory biomarkers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and pentraxin-3 (PTX-3) were measured. Performance of the qualitative diagnoses and the quantitative correlation were, respectively, compared by receiver operating characteristic (ROC) curve and Spearman correlation coefficient.
RESULTS The biomarkers (CRP, ESR, PTX-3), PET uptake values (SUVmax, PETVAS), and ITAS-2010 scores were all significantly higher in active patients than in non-active ones. The area under the ROC curve and Youden Index of PETVAS and PTX-3 were higher than those of SUVmax, CRP, ESR, and ITAS-2010. PETVAS and PTX-3 resulted in a higher Spearman correlation coefficient with ITAS-2010 than other criteria, either among all patients or within the active group. Alteration trends of PETVAS and PTX-3 during follow-up showed a tighter correlation with clinical progression/remission assessment than other criteria.
CONCLUSIONS In TAK evaluation, PETVAS is superior for qualitative and quantitative assessment, compared with the regional SUVmax. Compared to CRP and ESR, inflammatory biomarker PTX-3 shows better qualitative performance and a higher correlation with PETVAS and ITAS-2010. These findings indicate that the use of PETVAS and PTX-3, instead of SUVmax and CRP/ESR, has potential advantages in the clinical evaluation of TAK.

as reported in: Eur J Nucl Med Mol Imaging. 2020 Jun 22 [Epub ahead of print]