Polymyalgia rheumatica in the 2018–2020 guidelines. Part II: diagnosis of vasculitis

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О.H. Puzanova
А.А. Lyzikov


The issue of improved diagnosis of both rheumatic diseases of the elderly and aortic diseases does not lose its relevance. In terms of aortic aneurysms, dissection and ruptures and their attended pathogenesis, both inflammation and structural wall damages may be detected with imaging methods whose role is vital. A number of international guidelines deal with the ma­nagement of polymyalgia rheumatica, giant cell arteritis, or aortic aneurysms. Aortitis is associated with up to 40 % of polymyalgia rheumatica’s cases. The clinical suspicion of aortitis is based on the detection of blood pressure and pulse asymmetry, aortic regurgitation murmur, vascular bruits, as well as persistent polymyalgia rheumatica or inflammatory dorsalgia, pelvis or leg pain. In 2020, the positron emission tomography/computed tomography’s use is approved by the Italian Society for Rheumatology for the diagnosis of vasculitis attended by polymyalgia rheumatica at the secon­dary healthcare level and by the European Headache Federation for the diagnosis of large vessel giant cell arteritis in the neurological practice. A review of the guideline by the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the American Society of Nuclear Cardiology (2018) was performed in terms of po­sitron emission tomography with fluorodesoxyglucose combined with computed tomography (angiography) imaging in large vessel vasculitis and polymyalgia rheumatica. It is further compared with the clinical guidelines, other guidelines by the societies of nuclear medicine and new scientific data. Both procedure and patient’s preparation for examination are decribed. The criteria for assessing vasculitis proposed for either clinical practice or cli­nical studies are consi­dered, as well as the factors influencing the test results and their interpretation (such as atherosclerosis, diabetes, age, body mass index, glucemia’s and acute phase markers’ levels). The guideline substantiates the benefit of both positron emission tomography’s use and its combination with computed tomography to detect extracranial vasculitis, as well as the va­lue of performing computed tomography-angiography at different stages of the disease. There is a need to strengthen evidence on both standard time of fluorodesoxyglucose exposure and the benefit of combining positron emission tomography with computed tomography-angiography, in particular for detection of vasculitis relapses. Finding a consensus for early test’s performing is nee­ded, as well as its score standardization, ensuring reimbursement and implementation of new imaging techniques for the cranial vessels. In the future, the evidence-based approach to managing vasculitis will be supplemented by teranostics.

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Puzanova О., and Lyzikov А. “Polymyalgia Rheumatica in the 2018–2020 Guidelines. Part II: Diagnosis of Vasculitis”. PAIN, JOINTS, SPINE, vol. 11, no. 1, Apr. 2021, pp. 1-16, doi:10.22141/2224-1507.11.1.2021.226904.


Bunchuk NV. Revmaticheskie zabolevaniia pozhilykh (izbrannye) [Rheumatic diseases of the elderly (selected)]. Moscow: MEDpress-inform; 2010. 272 p. (in Russian).

Mansalis K. Myalgias and Myopathies: Polymyalgia Rheumatica and Giant Cell Arteritis. FP Essent. 2016 Jan;440:16-22.

Pioro MH. Primary Care Vasculitis: Polymyalgia Rheumatica and Giant Cell Arteritis. Prim Care. 2018 Jun;45(2):305-323. https://doi.org/10.1016/j.pop.2018.02.007.

Matteson EL, Buttgereit F, Dejaco C, Dasgupta B. Glucocorticoids for Management of Polymyalgia Rheumatica and Giant Cell Arteritis. Rheum Dis Clin North Am. 2016 Feb;42(1):75-90, viii. https://doi.org/10.1016/j.rdc.2015.08.009.

Hellmich B. Management of polymyalgia rheumatica and large vessel vasculitis. Internist. 2016;57(11):1069-1078. https://doi.org/10.1007/s00108-016-0131-x. (in German).

Hamrin B, Jonsson N, Hellsten S. "Polymyalgia arteritica". Further clinical and histopathological studies with a report of six autopsy cases. Ann Rheum Dis. 1968 Sep;27(5):397-405. https://doi.org/10.1136/ard.27.5.397.

Сimmino MA, Camellino D. Large vessel vasculitis: which imaging method? Swiss Med Wkly. 2017 Mar;147:w14405. https://doi.org/10.4414/smw.2017.14405.

Smiyan S, Holovach I, Komorovsky R, Kmetyuk Y, Ashykhmin A. Role of PET/CT in the diagnosis of large vessel vasculitis in a patient with systemic inflammatory response syndrome. Eur J Rheumatol. 2014 Dec;1(4):174-175. https://doi.org/10.5152/eurjrheumatol.2014.140078.

Camellino D, Cimmino MA. Imaging of polymyalgia rheumatica: indications on its pathogenesis, diagnosis and prognosis. Rheumatology (Oxford). 2012 Jan;51(1):77-86. https://doi.org/10.1093/rheumatology/keq450.

Liozon E, de Boysson H, Dalmay F, et al. Development of Giant Cell Arteritis after Treating Polymyalgia or Peripheral Arthritis: A Retrospective Case-control Study. J Rheumatol. 2018 May;45(5):678-685. https://doi.org/10.3899/jrheum.170455.

Lensen KD, Voskuyl AE, Comans EF, van der Laken CJ, Smulders YM. Extracranial giant cell arteritis: A narrative review. Neth J Med. 2016 Jun;74(5):182-192.

Netiazhenko VZ, Puzanovа ОG. Giant cell arteritis: epidemiology, diagnosis, prognosis. Bolʹ, sustavy, pozvonočnik. 2019;9(2):90-107. https://doi.org/10.22141/2224-1507.9.2.2019.172121. (in Russian).

Lyzikov AN, Puzanova OG, Lyzikov AA. Giant cell arteritis: proven and debatable aspects of treatment. Bolʹ, sustavy, pozvonočnik. 2020;10(1):17-38. https://doi.org/10.22141/2224-1507.10.1.2020.199720. (in Russian).

Niinimaki E, Kajander H, Paavonen T, Sioris T, Mennander A. Aiming at one-stage corrective surgery for extended thoracic aortic dilatation. Int J Angiol. 2014 Jun;23(2):101-106. https://doi.org/10.1055/s-0034-1370887.

Sato O, Takagi A, Miyata T, Takayama Y. Aortic aneurysm in patients with autoimmune disorders treated with corticosteroids. Eur J Vasc Endovasc Surg. 1995 Oct;10(3):366-369. https://doi.org/10.1016/S1078-5884(05)80059-0.

Erbel R, Aboyans V, Boileau C, et al. Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2015 Nov 1;36(41):2779. https://doi.org/10.1093/eurheartj/ehv178.

Kuznechevsky FV, Osipov AK, Evsikov EM, Abramov IS, Otarova SM. Prevalence and clinical features of aorta aneurysm; and dissections: 10-year results of consequent autopsies made at OM Filatov City Clinical Hospital №15. Russian Journal of Cardiology. 2004;(6):5-13. (in Russian).

Robson JC, Kiran A, Maskell J, et al. The relative risk of aortic aneurysm in patients with giant cell arteritis compared with the general population of the UK. Ann Rheum Dis. 2015 Jan;74(1):129-135. https://doi.org/10.1136/annrheumdis-2013-204113.

National Institute for Health and Care Excellence (NICE). Abdominal aortic aneurysm: diagnosis and management (NG156). London: National Institute for Health and Care Excellence (UK); 2020 Mar 19. 49 p.

Stone JR, Bruneval P, Angelini A, et al. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol. 2015 Sep-Oct;24(5):267-78. https://doi.org/10.1016/j.carpath.2015.05.001.

Canadian Task Force on Preventive Health Care. Recommendations on screening for abdominal aortic aneurysm in primary care. CMAJ. 2017 Sep 11;189(36):E1137-E1145. https://doi.org/10.1503/cmaj.170118.

Kuzmik GA, Sang AX, Elefteriades JA. Natural history of thoracic aortic aneurysms. J Vasc Surg. 2012 Aug;56(2):565-571. https://doi.org/10.1016/j.jvs.2012.04.053.

Kozlov BN, Panfilov DS, Gutor SS, et al. Morphological state of the aortic wall in ascending aortic aneurysm. Clin Experiment Surg Petrovsky J. 2018;6(4):43-48. https://doi.org/10.24411/2308-1198-2018-14006. (in Russian).

Lariviere D, Benali K, Coustet B, et al. Positron emission tomography and computed tomography angiography for the diagnosis of giant cell arteritis: A real-life prospective study. Medicine (Baltimore). 2016 Jul;95(30):e4146. https://doi.org/10.1097/md.0000000000004146.

Saeyeldin AA, Velasques CA, Mahmood SUB, et al. Thoracic aortic aneurysm: unlocking the «silent killer» secrets. Gen Thorac Cardiovasc Surg. 2019;67(1):1-11. https://doi.org/10.1007/s11748-017-0874-x.

Koster MJ, Matteson EL, Warrington KJ. Large-vessel giant cell arteritis: diagnosis, monitoring and management. Rheumatology (Oxford). 2018 Feb 1;57(Suppl_2):ii32-ii42. https://doi.org/10.1093/rheumatology/kex424.

Löffler C, Hoffend J, Benck U, Krämer BK, Bergner R. The value of ultrasound in diagnosing extracranial large-vessel vasculitis compared to FDG-PET/CT: A retrospective study. Clin Rheumatol. 2017 Sep;36(9):2079-2086. https://doi.org/10.1007/s10067-017-3669-7.

Quinn KA, Grayson PC. The Role of Vascular Imaging to Advance Clinical Care and Research in Large-Vessel Vasculitis. Curr Treatm Opt Rheumatol. 2019 Mar;5(1):20-35. https://doi.org/10.1007/s40674-019-00114-0.

Villiger PM. Large vessel vasculitis: Giant cell arteritis and Takayasu arteritis. Z Rheumatol. 2017 Aug;76(6):509-523. https://doi.org/10.1007/s00393-017-0331-3. (in German).

Nielsen BD, Gormsen LC, Hansen IT, Keller KK, Therkildsen P, Hauge EM. Three days of high-dose glucocorticoid treatment attenuates large-vessel 18F-FDG uptake in large-vessel giant cell arteritis but with a limited impact on diagnostic accuracy. Eur J Nucl Med Mol Imaging. 2018 Jul;45(7):1119-1128. https://doi.org/10.1007/s00259-018-4021-4.

Mollan SP, Paemeleire K, Versijpt J, Luqmani R, Sinclair AJ. European Headache Federation recommendations for neurologists managing giant cell arteritis. J Headache Pain. 2020 Mar 17;21(1):28. https://doi.org/10.1186/s10194-020-01093-7.

Dasgupta B, Cimmino MA, Maradit-Kremers H, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2012 Apr;71(4):484-492. https://doi.org/10.1136/annrheumdis-2011-200329.

Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2015 Oct;74(10):1799-1807. https://doi.org/10.1136/annrheumdis-2015-207492.

Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis. 2018 May;77(5):636-643. https://doi.org/10.1136/annrheumdis-2017-212649.

Dasgupta B, Borg FA, Hassan N, et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford). 2010 Aug;49(8):1594-1597. https://doi.org/10.1093/rheumatology/keq039a.

Bienvenu B, Ly KH, Lambert M, et al. Management of giant cell arteritis: Recommendations of the French Study Group for Large Vessel Vasculitis (GEFA). Rev Med Interne. 2016 Mar;37(3):154-165. https://doi.org/10.1016/j.revmed.2015.12.015.

Mackie SL, Dejaco C, Appenzeller S, et al. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology (Oxford). 2020 Mar 1;59(3):e1-e23. https://doi.org/10.1093/rheumatology/kez672.

Buttgereit F, Brabant T, Dinges H, et al. S3 guideline on treatment of polymyalgia rheumatica: evidence based guideline of the German Society of Rheumatology (DGRh), the Austrian Society of Rheumatology and Rehabilitation (ÖGR) and the Swiss Society of Rheumatology (SGR) and participating medical scientific specialist societies and other organizations. Z Rheumatol. 2018 Jun;77(5):429-441. https://doi.org/10.1007/s00393-018-0476-8. (in German).

Ughi N, Sebastiani GD, Gerli R, et al. The Italian Society of Rheumatology clinical practice guidelines for the management of polymyalgia rheumatica. Reumatismo. 2020 Apr 10;72(1):1-15. https://doi.org/10.4081/reumatismo.2020.1268.

Schirmer JH, Aries PM, Balzer K, et al. S2k-Leitlinie: Management der Großgefäßvaskulitiden [S2k guidelines: management of large-vessel vasculitis. Z Rheumatol. 2020 Nov;79(Suppl 3):67-95. https://doi.org/10.1007/s00393-020-00893-1. (in German).

Puzanova ОG, Moshkovska YuO, Sobol VO. Polymyalgia rheumatica: concerted efforts of the European rheumatological societies. Bolʹ, sustavy, pozvonočnik. 2020;10(3):118-126. https://doi.org/10.22141/2224-1507.10.3.2020.212033.

Slart RHJA; Writing group; Reviewer group, et al. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging. 2018 Jul;45(7):1250-1269. https://doi.org/10.1007/s00259-018-3973-8.

Jamar F, Buscombe J, Chiti A, et al. EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med. 2013 Apr;54(4):647-658. https://doi.org/10.2967/jnumed.112.112524.

Boellaard R, Delgado-Bolton R, Oyen WJ, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015 Feb;42(2):328-354. https://doi.org/10.1007/s00259-014-2961-x.

Dorbala S, Di Carli MF, Delbeke D, et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med. 2013 Aug;54(8):1485-1507. https://doi.org/10.2967/jnumed.112.105155.

Chareonthaitawee P, Beanlands RS, Chen W, et al. Joint SNMMI-ASNC Expert Consensus Document on the Role of 18F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring. J Nucl Med. 2017 Aug;58(8):1341-1353. https://doi.org/10.2967/jnumed.117.196287.

Bucerius J, Hyafil F, Verberne HJ, et al. Position paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM) on PET imaging of atherosclerosis. Eur J Nucl Med Mol Imaging. 2016 Apr;43(4):780-792. https://doi.org/10.1007/s00259-015-3259-3.

American College of Radiology; North American Society for Cardiovascular Imaging; Society of Interventional Radiology; Society for Pediatric Radiology. ACR-NASCI-SIR-SPR practice parameter for the performance and interpretation of body computed tomography angiography (CTA). Revised 2016 (Resolution 16). Available from: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Body-CTA.pdf?la=en. Accessed: October 26, 2017.

Hyafil F, Vigne J. Nuclear Imaging: Focus on Vascular Probes. Arterioscler Thromb Vasc Biol. 2019 Jul;39(7):1369-1378. https://doi.org/10.1161/atvbaha.119.312586.

Ernst D, Baerlecken NT, Schmidt RE, Witte T. Large vessel vasculitis and spondyloarthritis: coincidence or associated diseases? Scand J Rheumatol. 2014;43(3):246-248. https://doi.org/10.3109/03009742.2013.850737.

Yamashita H, Kubota K, Takahashi Y, et al. Whole-body fluorodeoxyglucose positron emission tomography/computed tomography in patients with active polymyalgia rheumatica: evidence for distinctive bursitis and large-vessel vasculitis. Mod Rheumatol. 2012 Sep;22(5):705-711. https://doi.org/10.1007/s10165-011-0581-x.

Kubota K, Yamashita H, Mimori A. Clinical Value of FDG-PET/CT for the Evaluation of Rheumatic Diseases: Rheumatoid Arthritis, Polymyalgia Rheumatica, and Relapsing Polychondritis. Semin Nucl Med. 2017 Jul;47(4):408-424. https://doi.org/10.1053/j.semnuclmed.2017.02.005.

Yuge S, Nakatani K, Yoshino K, Koyama T. Diagnosing polymyalgia rheumatica on 18F-FDG PET/CT: typical uptake patterns. Ann Nucl Med. 2018 Oct;32(8):573-577. https://doi.org/10.1007/s12149-018-1269-5.

Bakos A, Besenyi Z, Sipka G, et al. 18F-FDG-PET/CT in the evaluation and differential diagnosis of active large-vessel vasculitis. A prospective study. Orv Hetil. 2020 May 1;161(20):829-838. https://doi.org/10.1556/650.2020.31710. (in Hungarian).

Cimmino MA, Camellino D, Paparo F, et al. High frequency of capsular knee involvement in polymyalgia rheumatica/giant cell arteritis patients studied by positron emission tomography. Rheumatology (Oxford). 2013 Oct;52(10):1865-1872. https://doi.org/10.1093/rheumatology/ket229.

Malik D, Verma R, Gupta V, et al. Semiquantitative Interpretation Criteria for Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Large-Vessel Vasculitis: Pattern Recognition and Correlation with Polymyalgia Rheumatica. Indian J Nucl Med. 2020 Jan-Mar;35(1):6-12. https://doi.org/10.4103/ijnm.ijnm_136_19.

Lavado-Pérez C, Martínez-Rodríguez I, Martínez-Amador N, et al. (18)F-FDG PET/CT for the detection of large vessel vasculitis in patients with polymyalgia rheumatica. Rev Esp Med Nucl Imagen Mol. 2015 Sep-Oct;34(5):275-281. https://doi.org/10.1016/j.remn.2015.05.011.

Rehak Z, Vasina J, Nemec P, et al. Various forms of (18)F-FDG PET and PET/CT findings in patients with polymyalgia rheumatica. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015 Dec;159(4):629-636. https://doi.org/10.5507/bp.2015.026.

Einspieler I, Thürmel K, Pyka T, et al. Imaging large vessel vasculitis with fully integrated PET/MRI: a pilot study. Eur J Nucl Med Mol Imaging. 2015 Jun;42(7):1012-1024. https://doi.org/10.1007/s00259-015-3007-8.

De Boysson H, Dumont A, Liozon E, et al. Giant-cell arteritis: concordance study between aortic CT angiography and FDG-PET/CT in detection of large-vessel involvement. Eur J Nucl Med Mol Imaging. 2017 Dec;44(13):2274-2279. https://doi.org/10.1007/s00259-017-3774-5.

Einspieler I, Thürmel K, Eiber M. Fully integrated whole-body [18F]-fludeoxyglucose positron emission tomography/magnetic resonance imaging in therapy monitoring of giant cell arteritis. Eur Heart J. 2016 Feb 7;37(6):576. https://doi.org/10.1093/eurheartj/ehv607.

Prieto-Peña D, Martínez-Rodríguez I, Loricera J, et al. Predictors of positive 18F-FDG PET/CT-scan for large vessel vasculitis in patients with persistent polymyalgia rheumatica. Semin Arthritis Rheum. 2019 Feb;48(4):720-727. https://doi.org/10.1016/j.semarthrit.2018.05.007.

Bucerius J, Mani V, Moncrieff C, et al. Optimizing 18F-FDG PET/CT imaging of vessel wall inflammation: the impact of 18F-FDG circulation time, injected dose, uptake parameters, and fasting blood glucose levels. Eur J Nucl Med Mol Imaging. 2014 Feb;41(2):369-383. https://doi.org/10.1007/s00259-013-2569-6.

Huet P, Burg S, Le Guludec D, Hyafil F, Buvat I. Variability and uncertainty of 18F-FDG PET imaging protocols for assessing inflammation in atherosclerosis: suggestions for improvement. J Nucl Med. 2015 Apr;56(4):552-559. https://doi.org/10.2967/jnumed.114.142596.

Rosenblum JS, Quinn KA, Rimland CA, Mehta NN, Ahlman MA, Grayson PC. Clinical Factors Associated with Time-Specific Distribution of 18F-Fluorodeoxyglucose in Large-Vessel Vasculitis. Sci Rep. 2019 Oct 23;9(1):15180. https://doi.org/10.1038/s41598-019-51800-x.

Watanabe R, Hilhorst M, Zhang H, et al. Glucose metabolism controls disease-specific signatures of macrophage effector functions. JCI Insight. 2018 Oct 18;3(20):e123047. https://doi.org/10.1172/jci.insight.123047.

Lai LYH, Harris E, West RM, Mackie SL. Association between glucocorticoid therapy and incidence of diabetes mellitus in polymyalgia rheumatica and giant cell arteritis: a systematic review and meta-analysis. RMD Open. 2018 Feb 28;4(1):e000521. https://doi.org/10.1136/rmdopen-2017-000521.

Halliburton SS, Abbara S, Chen MY, et al. SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr. 2011 Jul-Aug;5(4):198-224. https://doi.org/10.1016/j.jcct.2011.06.001.

Agard C, Barrier JH, Dupas B, et al. Aortic involvement in recent-onset giant cell (temporal) arteritis: a case-control prospective study using helical aortic computed tomodensitometric scan. Arthritis Rheum. 2008 May 15;59(5):670-676. https://doi.org/10.1002/art.23577.

Prieto-González S, Arguis P, García-Martínez A, et al. Large vessel involvement in biopsy-proven giant cell arteritis: prospective study in 40 newly diagnosed patients using CT angiography. Ann Rheum Dis. 2012 Jul;71(7):1170-1176. https://doi.org/10.1136/annrheumdis-2011-200865.

Prieto-González S, García-Martínez A, Tavera-Bahillo I, et al. Effect of glucocorticoid treatment on computed tomography angiography detected large-vessel inflammation in giant-cell arteritis. A prospective, longitudinal study. Medicine (Baltimore). 2015 Feb;94(5):e486. https://doi.org/10.1097/md.0000000000000486.

Lensen KD, Comans EF, Voskuyl AE, et al. Large-vessel vasculitis: interobserver agreement and diagnostic accuracy of 18F-FDG-PET/CT. Biomed Res Int. 2015;2015:914692. https://doi.org/10.1155/2015/914692.

Soussan M, Nicolas P, Schramm C, et al. Management of large-vessel vasculitis with FDG-PET: a systematic literature review and meta-analysis. Medicine (Baltimore). 2015 Apr;94(14):e622. https://doi.org/10.1097/md.0000000000000622.

Rehák Z, Szturz P. Comment on: FDG PET in the early diagnosis of large-vessel vasculitis. Eur J Nucl Med Mol Imaging. 2014 Mar;41(3):579-580. https://doi.org/10.1007/s00259-013-2662-x.

Lehmann P, Buchtala S, Achajew N, et al. 18F-FDG PET as a diagnostic procedure in large vessel vasculitis-a controlled, blinded re-examination of routine PET scans. Clin Rheumatol. 2011 Jan;30(1):37-42. https://doi.org/10.1007/s10067-010-1598-9.

Besson FL, de Boysson H, Parienti JJ, Bouvard G, Bienvenu B, Agostini D. Towards an optimal semiquantitative approach in giant cell arteritis: an (18)F-FDG PET/CT case-control study. Eur J Nucl Med Mol Imaging. 2014 Jan;41(1):155-166. https://doi.org/10.1007/s00259-013-2545-1.

Stellingwerff MD, Brouwer E, Lensen KDF, et al. Different Scoring Methods of FDG PET/CT in Giant Cell Arteritis: Need for Standardization. Medicine (Baltimore). 2015 Sep;94(37):e1542. https://doi.org/10.1097/md.0000000000001542.

Bai B, Bading J, Conti PS. Tumor quantification in clinical positron emission tomography. Theranostics. 2013 Oct 7;3(10):787-801. https://doi.org/10.7150/thno.5629.

Gholami S, Salavati A, Houshmand S, Werner TJ, Alavi A. Assessment of atherosclerosis in large vessel walls: A comprehensive review of FDG-PET/CT image acquisition protocols and methods for uptake quantification. J Nucl Cardiol. 2015 Jun;22(3):468-479. https://doi.org/10.1007/s12350-015-0069-8.

Lensen KDF, van Sijl AM, Voskuyl AE, et al. Variability in quantitative analysis of atherosclerotic plaque inflammation using 18F-FDG PET/CT. PLoS One. 2017 Aug 11;12(8):e0181847. https://doi.org/10.1371/journal.pone.0181847.

Lee YH, Choi SJ, Ji JD, Song GG. Diagnostic accuracy of 18F-FDG PET or PET/CT for large vessel vasculitis : A meta-analysis. Z Rheumatol. 2016 Nov;75(9):924-931. https://doi.org/10.1007/s00393-015-1674-2.

Moosig F, Czech N, Mehl C, et al. Correlation between 18-fluorodeoxyglucose accumulation in large vessels and serological markers of inflammation in polymyalgia rheumatica: a quantitative PET study. Ann Rheum Dis. 2004 Jul;63(7):870-873. https://doi.org/10.1136/ard.2003.011692.

Castellani M, Vadrucci M, Florimonte L, Caronni M, Benti R, Bonara P. 18F-FDG uptake in main arterial branches of patients with large vessel vasculitis: visual and semiquantitative analysis. Ann Nucl Med. 2016 Jul;30(6):409-420. https://doi.org/10.1007/s12149-016-1075-x.

Kitajima K, Suenaga Y, Sugimura K. Present and future role of FDG-PET/CT imaging in the management of head and neck carcinoma. Jpn J Radiol. 2015 Dec;33(12):776-789. https://doi.org/10.1007/s11604-015-0495-1.

Nielsen BD, Hansen IT, Kramer S, et al. Simple dichotomous assessment of cranial artery inflammation by conventional 18F-FDG PET/CT shows high accuracy for the diagnosis of giant cell arteritis: a case-control study. Eur J Nucl Med Mol Imaging. 2019 Jan;46(1):184-193. https://doi.org/10.1007/s00259-018-4106-0.

Sammel AM, Hsiao E, Schembri G, et al. Diagnostic Accuracy of Positron Emission Tomography/Computed Tomography of the Head, Neck, and Chest for Giant Cell Arteritis: A Prospective, Double-Blind, Cross-Sectional Study. Arthritis Rheumatol. 2019 Aug;71(8):1319-1328. https://doi.org/10.1002/art.40864.

Salvatori M, Rizzo A, Rovera G, Indovina L, Schillaci O. Radiation dose in nuclear medicine: the hybrid imaging. Radiol Med. 2019 Aug;124(8):768-776. https://doi.org/10.1007/s11547-019-00989-y.