Absztrakt: Bevezetés: A nagyérvasculitisek nem specifikus klinikai tüneteket okoznak, ami a diagnózist nagyban nehezíti. A betegség korai felismerése és kezelése a későbbi szövődmények elkerülése érdekében fontos. A 18F-FDG-PET az érfalon belüli gyulladást a betegség korai stádiumában is nagy érzékenységgel mutatja ki. A CT a nagyérvasculitis pontos lokalizációjában van segítségünkre. Célkitűzés: A 18F-FDG-PET/CT teljesítőképességének tisztázása a betegség aktivitásának és kiterjedésének megítélésében: klinikailag nagyérvasculitis iránydiagnózisával vizsgált betegekben és relapsus során, valamint a terápiára létrejövő remissio megállapításában. Módszer: A vizsgálatban 43 beteg vett részt. A betegeket a klinikai kérdés alapján csoportosítottuk: primer diagnózis igazolása szteroidnaiv és szteroiddal kezelt betegekben, relapsus, illetve remissio kimutatása. Kontrollként 10, gyulladásos tünetektől mentes tumoros beteget vizsgáltunk meg. Az erek radiofarmakon-felvételének mértékét vizuálisan és kvantitatívan értékeltük. A kvantitatív értékelés során az érszegmentumokban a májhoz viszonyított érfal maximális standard 18F-FDG-felvételi értékét (SUVmax) határoztuk meg. Eredmények: A primer diagnózis céljából végzett 30 vizsgálatból 5 esetben 18F-FDG-aktív nagyérvasculitist mutattunk ki, további 13 vizsgálatból 5 betegben pedig relapsust igazoltunk. A vizuálisan aktív betegek 50%-ában 3 vagy annál több aktív érszegmentumot találtunk. A vizuálisan aktív betegcsoportban szteroid hatására az érfal SUVmax-értéke szignifikánsan alacsonyabb volt a szteroidnaiv betegekhez képest (1,17 ± 0,11 vs. 1,43 ± 0,29; p = 0,005). Két 18F-FDG-aktív nagyér-vasculitises betegben kontrollvizsgálattal remissiót állapítottunk meg. A primer diagnózis céljából vizsgált esetek közül 8-ban egyéb, a nagyérvasculitistől független gyulladásos kórképet mutattunk ki. Következtetés: A 18F-FDG-PET/CT hatékonyan alkalmazható az aktív nagyérvasculitisek diagnosztizálásában. A metabolikus változás nagy érzékenységű megjelenítése mellett az érintett erek pontos lokalizációját is lehetővé teszi. A szteroidterápia befolyásolja az érfalak 18F-FDG-felvételét. Orv Hetil. 2020; 161(20): 829–838.

Background99Tc hydroxyl-disphophonate SPECT-CT (HDP SPECT-CT) is a hybrid imaging technology, which is a new modality in the examination of the sacroiliac joint. It is a high resolution, low dose structural computer tomography scan fused with a functional metabolism recording. Our aim was to investigate whether it is comparable in sensitivity with MRI, to analyse quantitatively the radioisotope uptake, to assess its potential in the assessment of inflammatory activity, and in the diagnosis of spondylarthitis (SpA).ObjectivesSeventeen patients (9 women, 8 men, mean age 35 years) were involved into the study from July 2016. The patients were selected according the following clinical features: inflammatory type low back pain raising the suspicion of axial SpA,17 elevated CRP level,6 HLA-B27 positivity,8 associated oligo- or polyarthritis,5 dactylitis,1 enthesitis,1 psoriasis,1 uveitis1 and inflammatory bowel disease.1 All patients were therapeutic-naive for glucocorticostreroids, DMARDs or TNF-α inhibitors.MethodsFirst, we performed examination of the sacroiliac joint with X-ray, to exclude those patients, who already had radiographic lesions. Then an MRI was performed in the following sequences: T2- weighted STIR for the bone marrow oedema (BME) and T1-weighted sequence for the fat metaplasia (FM). The HDP SPECT/CT was used within one week to examine the sacroiliac joint. Thereafter, the MRI images were fused with HDP SPECT/CT images. On the MRI images the BME (active lesion) and FM (chronic lesion), on the CT scans the sclerotic lesions (SCL, chronic lesion) were drawn manually as volume of interest (VOI). Uninvolved cortical areas were drawn on the different modality slices as reference region (ref). Then, we determined the isotope (99mTc-labelled HDP) uptake of the different lesions and areas.ResultsFour active sacroileitis and five chronic sacroileitis without active lesions were diagnosed according to the MRI results. On the other 8 patient’s sacroiliac joints images (MRI, scintigraphy, CT scans), no inflammation-related lesions were observed. The MRI and HDP SPECT-CT findings were 100% concordant. The isotope uptake of BME was the highest, the radioisotope uptake of sclerotic lesions was moderate, whereas the isotope uptake of FM lesions was not different from the HDP uptake of reference regions.ConclusionsAccording to the initial results, the different MRI lesions have different isotope uptake, which suggests, that the HDP SPECT/CT can distinguish the early and chronic stage of axial SpA from chronic lesions. Thank to whole body imaging technique we can have further information about disease activity and extent. The presented data are the first of our prospective study, and examinations of new patients are still in progress and we plan to investigate our SpA patients in remission to explore the utility of this new method in subclinical activity assessment. We also plan to investigate the corner lesions of the spine to find other potential uses of the HDP SPECT-CT imaging in SpA.Disclosure of InterestNone decl...

Objective: To evaluate the relationship between aortic inflammation as assessed by 18F-FDG-PET and features of coronary plaque vulnerability as assessed by FD-OCT Methods: We enrolled 30 NSTE-ACS patients undergoing PCI. All patients underwent 3-vessel OCT before intervention and 18F-FDG-PET before discharge. Univariable and C-reactive protein (CRP)-adjusted linear regression analyses were performed between features of vulnerability and 18F-FDG uptake in both ascending (AA) and descending aorta (DA) Results: On linear regression analysis TBRmean and TBRmax in DA was associated with the number of lipid-rich plaques (β=4.22; 95% CI 0.05-8.39; p=0.047 and β=3.72; 95% CI 1.14-6.30; p=0.006, respectively). TBRmax in DA was also associated with the number of lipid-rich plaques containing macrophages (β=2.40; 95% CI 0.07-4.72; p=0.044) [Table]. A CRP adjusted linear association between the TBRmax in DA and the number of lipid-rich plaques was observed (CRP-adjusted β=3.58; 95% CI -0.91-6.25; p=0.01). TBRmax in DA showed a trend towards significant CRP-adjusted association with number of lipid-rich plaques with macrophages (β=2.30; 95% CI-0.11-4.

Objective. Cardiopulmonary exercise test (CPET) is a widely used examination to predict the prognosis of many chronic pulmonary diseases, and it has also been tested in systemic sclerosis (SSc) with a focus on the development of pulmonary hypertension. CPET is a highly informative non-invasive tool that provides a more complex information than conventional lung function tests to predict the course of cardiopulmonary diseases, as it provides a general overview of the aerobic metabolism, influenced by pulmonary, cardiovascular and peripheral muscle function. The purpose of this investigation was to assess if the progression and the development of poor overall disease outcome in SSc can be predicted by this method. Methods. Twenty-nine SSc patients were investigated prospectively with standard follow-up plus CPET for a mean of 3.7 years to match the results of conventional evaluation modalities and CPET. A composite end-point of several serious outcomes reflecting SSc-related vascular and cardiopulmonary damage was set up, and the predictive value of and correlations between the CPET parameters and resting lung function and echocardiography variables were assessed. Results. None of the clinical parameters, resting lung function or echocardiographic test results proved to be predictive of the development of the endpoint of poor prognosis in this cohort.In contrast, several CPET parameters were found to discriminate between SSc patients with or without adverse outcome. The detection of desaturation (at any CPET test) was associated with a higher risk of poor prognosis (OR: 5.265). VO 2 and VE/VCO 2 at baseline correlated with the annual decrease in FVC, anaerobic threshold with the development of digital ulcers, and VE/ VO 2 with the increase in pulmonary arterial pressure. Conclusion. Several CPET parameters obtained at the beginning of follow-up are informative of the appearance of various adverse end-points. CPET is a feasible examination in the care of SSc patients and provides excess information to current standard follow-up examinations.

Background:CPET is a widely used examination to predict the prognosis of chronic obstructive pulmonary disease or post-transplant lung function, and it has also been examined in the context of respiratory tract involvement and pulmonary hypertension in systemic slerosis (SSc).Objectives:As CPET provides a general overview of the aerobic metabolism, influenced by pulmonary, cardiac and vascular function, the purpose of this investigation was to assess if development of poor overall disease outcome could be predicted by CPET.Methods:Twenty-nine SSc patients (M/F=5/24 DcSSc/LcSSc=16/13) were investigated repeatedly with CPET and followed for a mean of 3.7 (range 1-7) years. The clinical features of the patients were the following: alveolitis (n=15), pulmonary fibrosis (n=16), digital ulcers (n=13), 5 of them required bosentan therapy, macroangiopathy (n=8), GERD (n=26), Barrett metaplasia (n=19), gastrintestinal angiopathy (n=5), motility disorder (n=10), pulmonary artery hypertension (pPulm >40 mmHg) (n=4). The average disease duration was 8.9 years. A composite end point was set up: death or digital ulceration necessitating bosentan therapy or pulmonary hypertension (Ppulm>40mmHg) or the decrease of carbon-monoxide diffusion capacity (δDLCO) > 2%/year, or increase in pulmonary artery pressure (δPpulm) >3mmHg/year). Paralell with the CPET, conventional disease activity check-ups have been performed too (echocardiography, chest CT, resting lung function tests, clinical examinations). The correlations between the CPET mesurements and conventional findings and the predictive value of CPET parameters at the first visit to the future development of the composite end-point have been examined.Results:Various CPET results (anaerobic threshold (AT), work rate (WR), desaturation) have significantly correlated with worsening DLCO (p<0,05; Pearson’s correlation). The change of aT per year (δAT/yr) and the degree of desaturation during exercise predicted the development of poor prognostic end-point (p<0.05 with logistic regression), and the detection of desaturation at the first CPET test was associated with a higher risk of poor prognosis (OR: 5,265 [95% CI 1,077-29,38] p=0.057). In contrast, none of the standard pulmonary or cardiac parameters have proved to be predictive to the end-point in this cohort.Conclusion:CPET parameters correlate well with the standard assessment tools, indicating that this test is feasible in SSc patients too. The changes of aT during follow-up and desaturation are predictive to the appearence of the end point designed to comprise multiple features of the disease. This makes CPET a promising non-invasive examination method to estimate the progression of disease in patients suffering from systemic sclerosis.Disclosure of interests: None declared