Updated procedural guideline/procedure standard [18F]FDG-PET/CT(A) in large vessel vasculitis and polymyalgia rheumatica of the EANM, SNMMI, ASNC, CANM, ANZSNM and endorsed by the CSNM
Year: 2026
Type: article
Abstract: Large vessel vasculitis (LVV) comprises inflammatory disorders that primarily affect large arteries, most notably Takayasu arteritis (TAK) and giant cell arteritis (GCA). GCA frequently coexists with polymyalgia rheumatica (PMR), reflecting a shared disease spectrum. [ 18 F]FDG-PET/CT is an established imaging modality and has become integral to the evaluation of these conditions. When performed alone or combined with CT angiography ([ 18 F]FDG-PET/CT(A)), it enables visualization of metabolic activity in inflamed arterial walls as well as characteristic periarticular involvement. Since publication of the previous procedural recommendations, substantial new evidence has emerged, prompting an update of guidance. This joint guideline, developed by EANM, SNMMI, ASNC, CANM, CSNM and ANZSNM, provides updated evidence-based recommendations and expert consensus on the use of [ 18 F]FDG-PET/CT(A) in LVV and PMR. It addresses patient preparation, tracer administration, image acquisition, interpretation, reporting, and radiation considerations, with a strong emphasis on standardization to improve diagnostic accuracy and reproducibility. The guideline highlights the impact of glucocorticoid therapy on PET sensitivity and provides disease-specific interpretation criteria for large-vessel (lvGCA) and cranial GCA (cGCA), TAK, and PMR, including validated visual grading systems and composite scores. Systematic reviews and meta-analyses demonstrate moderate to high diagnostic accuracy of [ 18 F]FDG-PET/CT in LVV and PMR. Current evidence does not support routine PET imaging for treatment monitoring or relapse prediction. However, [ 18 F]FDG-PET/CT is valuable for identifying vascular territories at risk of future structural damage. The guideline also reviews emerging developments, including PET/MRI, long axial field-of-view PET/CT systems, and novel radiotracers, and underscores the importance of training and harmonized practice. Overall, these updated procedural recommendations aim to strengthen international harmonization and establish robust standards for [ 18 F]FDG-PET/CT(A) imaging in LVV and PMR, supporting clinical decision-making and guiding future research.
Source: The EANM Journal
Authors: Riemer H.J.A. Slart, Giorgio Treglia, Gad Abikhzer, Ayaz Aghayev, Mark A. Ahlman, Jean Louis Alberini, Florent L. Besson, Ertugrul C. Bolek, Thorsten A. Bley, Dario Camellino, Panithaya Chareonthaitawee, Marco A. Cimmino, Christian Dejaco, Paola A. Erba, Georgina Espígol-Frigolé, Andor W.J.M. Glaudemans, Lars C. Gormsen, Peter C. Grayson, Elvis Hysa, Freimut Juengling, Kresten K. Keller, Conny J. van der Laken, Bonnia Liu, Lien Moreel, Robert J.H. Miller, Berit Dalsgaard Nielsen, Claire E. Owen, Aubert Roy, Maria Sandovici, Mehran M. Sadeghi, Andrew M. Scott, Christiane Wiefels, Jing Wang, Olivier Gheysens, Kornelis S.M. van der Geest
Institutions: University Medical Center Groningen, University of Groningen, University of Milano-Bicocca, University of Twente, Ente Ospedaliero Cantonale, Istituto Imaging della Svizzera Italiana, Università della Svizzera italiana, University of Lausanne, Jewish General Hospital, McGill University, Brigham and Women's Hospital, Harvard University, Mass General Brigham, University of Virginia, Centre National de la Recherche Scientifique, Centre Georges François Leclerc, Institut de Chimie Moléculaire de l'Université de Bourgogne, Université Bourgogne Europe, Inserm, Commissariat à l'Énergie Atomique et aux Énergies Alternatives, Université Paris-Saclay, Assistance Publique – Hôpitaux de Paris, Bicêtre Hospital, Gazi University, Universitätsklinikum Würzburg, Mayo Clinic, University of Genoa, Medical University of Graz, Krankenhaus Bruneck, Azienda Sanitaria dell'Alto Adige, Ospedale Papa Giovanni XXIII, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Universitat de Barcelona, Aarhus University, Aarhus University Hospital, National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, University of Bern, University of Alberta, Neuroscience and Mental Health Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam University Medical Centers, The University of Melbourne, Austin Hospital, Austin Health, Universitair Ziekenhuis Leuven, University of Calgary, Regional Hospital Horsens, Yale University, VA Connecticut Healthcare System, La Trobe University, Olivia Newton-John Cancer Research Institute, University of Ottawa, Ottawa Heart Institute, Xijing Hospital, Air Force Medical University, Cliniques Universitaires Saint-Luc, UCLouvain, KU Leuven
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7204174895