Early diagnosis and follow-up of aortitis with [18F]FDG PET and MRI

Abstract

The aim of this prospective study was to compare fluorine-18 fluorodeoxyglucose ([(18)F]FDG) positron emission tomography (PET) with magnetic resonance imaging (MRI) in patients with early aortitis, at the time of initial diagnosis and during immunosuppressive therapy. The study population consisted of 15 patients (nine females and six males; median age 62 years, range 26-76 years) who presented with fever of unknown origin or an elevated erythrocyte sedimentation rate or elevated C-reactive protein and who showed pathological aortic [(18)F]FDG uptake. Fourteen of these patients had features of early giant cell arteritis (GCA), while one had features of early Takayasu arteritis. During follow-up, seven PET scans were performed in six patients with GCA 4-30 months (median 19 months) after starting immunosuppressive medication. The results of [(18)F]FDG imaging were compared with the results of MRI at initial evaluation and during follow-up and with the clinical findings. At baseline, abnormal [(18)F]FDG uptake was present in 59/104 (56%) of the vascular regions studied in 15 patients. Seven follow-up PET studies were performed in six patients. Of 30 regions with initial pathological uptake in these patients, 24 (80%) showed normalisation of uptake during follow-up. Normalisation of [(18)F]FDG uptake correlated with clinical improvement and with normalisation of the laboratory findings. All except one of the patients with positive aortic [(18)F]FDG uptake were investigated with MRI and MRA. Thirteen of these 14 patients showed inflammation in at least one vascular region. Of 76 vascular regions studied, 41 (53%) showed vasculitis on MRI. Of 76 vascular regions studied with both PET and MRI, 47 were concordantly positive or negative on both modalities, 11 were positive on MRI only and 18 were positive on PET only. MRI was performed during follow-up in six patients: of 17 regions with inflammatory changes, 15 regions remained unchanged and two showed improvement. Whole-body [(18)F]FDG PET is valuable in the primary diagnosis of early aortitis. The results of [(18)F]FDG PET and MRI in the diagnosis of aortitis in this study were comparable, but FDG imaging identified more vascular regions involved in the inflammatory process than did MRI. In a limited number of patients [(18)F]FDG PET was more reliable than MRI in monitoring disease activity during immunosuppressive therapy.

Quantifying Pulmonary Inflammation in Cystic Fibrosis with Positron Emission Tomography

“…PET imaging with [ 18 F]FDG can detect tissue inflammation in a variety of different clinical settings (28)(29)(30), and quantification of inflammation using PET has been applied to the lungs (31,32). All studies to date suggest that during acute inflammation, increases in lung [ Glucose Metabolic Rate Radioactivity Ratio (ml blood/ml lung/min) (ml blood/ml lung) (ml blood/ml lung/min) (mg glucose/100 ml lung/min) (ml blood/ml lung) Normal subjects (n ϭ 6) 0.0007 Ϯ 0. parenchymal cells likely also contribute significantly to the PET imaging signal (36).…”

18F‐fluorodeoxyglucose positron emission tomography in the diagnosis and followup of idiopathic retroperitoneal fibrosis

“…In these conditions, it can detect occult areas of vascular inflammation and thus demonstrate the full extent and distribution of vasculitis (6,10,11); further- more, in Takayasu's arteritis, 18 F-FDG-PET proved to be more reliable than MRI in monitoring disease activity (10).…”

Childhood‐onset Takayasu arteritis: an update

“…This modality estimates both the degree and site of inflammation. Meller et al 44 reported that FDG-PET is more reliable than MRI in the follow-up of TA patients in limited situations. FDG-PET imaging is recommended for diagnosis of TA or its recurrence, especially in the presence of negative inflammatory markers; However, it is not economical as a routine procedure.…”