Effect of CRP value on ¹⁸F-FDG PET vascular positivity in Takayasu arteritis: a systematic review and per-patient based meta-analysis.

Abstract

The aim of this study was to quantify the association between the CRP value and ¹⁸F-FDG PET vascular positivity in Takayasu arteritis (TAK) through a structured dedicated systematic review and meta-analysis. From January 2000 to December 2016, the PubMed/MEDLINE database was searched for articles specifically dealing with the assessment of vascular inflammation using ¹⁸F-FDG PET and CRP biomarkers in TAK. Inclusion criteria for the qualitative analysis were (1) ¹⁸F-FDG PET used to assess the disease activity, (2) The use of the ACR criteria for the diagnosis of TAK, (3) No case mixed vasculitis (i.e., no giant cell arteritis), and (4) CRP concentration and clinical disease activity available. For the meta-analysis, PET-positive and PET-negative subgroups with the corresponding CRP concentrations were generated based on per patient data. The standard mean difference, which represents the effect of the CRP concentrations on the ¹⁸F-FDG PET vascular uptake, was computed for all studies, and then the results were pooled together. Among the 33 initial citations, nine complete articles including 210 patients fulfilled the inclusion criteria. Five studies found a significant correlation between the ¹⁸F-FDG PET and CRP concentration, one provided a trend towards association and three did not find any association between the two biomarkers. Six studies found a significant association between ¹⁸F-FDG PET and clinical disease activity, one found a trend towards association and the last two studies did not evaluate this correlation. The meta-analysis (121 patients) provided the following results: Standard Mean Deviation = 0.54 [0.15;0.92]; Chi² = 3.35; I² = 0%; Test for overall effect: Z = 2.70 (P = 0.007). The CRP concentration only moderately reflects the ¹⁸F-FDG PET vascular positivity in TAK, suggesting dissociated information. Standardized longitudinal prospective studies are necessary to assess the value of ¹⁸F-FDG PET as an independent biomarker for subtle vascular wall inflammation detection.