Fludeoxyglucose Positron Emission Tomography in the Diagnosis of Giant Cell Arteritis

Abstract

We describe a case in which fludeoxyglucose F 18 positron emission tomography (PET) led directly to the diagnosis of giant cell arteritis in an elderly woman with a fever of unknown origin. The patient presented with a 3-month history of fatigue, fever, headache, visual disturbance, jaw claudication, and anemia. A computed tomographic scan showed an anterior mediastinal mass that was suspected of being malignant. A fludeoxyglucose F 18 PET scan performed for preoperative evaluation identified striking uptake of fludeoxyglucose F 18 in the walls of the entire aorta, left main coronary artery, and subclavian, carotid, and common iliac arteries bilaterally, suggestive of an arteritis, a diagnosis subsequently confirmed by the findings of an arterial biopsy. Her erythrocyte sedimentation rate was 129 mm/h. There was normalizaton of the PET scan 2 weeks following treatment with prednisolone. This case suggests that fludeoxyglucose F 18 PET contributes to the noninvasive diagnosis of giant cell arteritis, as well as to the evaluation of the extent of disease, response to therapy, and disease recurrence.

Giant cell arteritis: a systemic vascular disease

“…61 Vascular tracer uptake in the aorta and in peripheral arteries was detected by 18F-FDG-PET and also in patients with GCA. 23,59,62,63,65,67 In a recent study, Blockmans et al 63 found a positive vascular 18F-FDG uptake in 29 of 35 (83%) patients with biopsy proven GCA, who did not have clinical symptoms of peripheral ischemia. Increased 18F-FDG uptake was most frequent in the subclavian artery (74%), followed by the aorta (51%) and the femoral arteries (37%).…”

“…44,[58][59][60][61][62][63] 18F-FDG-PET can be used as a whole-body Giant cell arteritis 135 screening tool, and this method has the potential of detecting arteritis in very early stages, before the occurrence of manifest arterial stenosis. Accordingly, several studies have demonstrated the usefulness of 18F-FDG-PET for the detection of largevessel vasculitis in patients with fever of unknown origin or unexplained systemic inflammation but without clinically manifest vascular symptoms.…”

Maladie de Horton et atteintes artérielles extratemporales : utilité de la tomographie par émission de positons au 18FDG. À propos de trois observations et d'une revue de la littérature

“…Derdelinckx signale pour sa part l'utilité de la TEP associée à la RMN pour le diagnostic et le suivi post-thérapeutique d'une aortite alors que la biopsie temporale est négative [24]. Plus récemment, à propos d'une patiente explorée pour une fièvre d'origine indéterminée, Turkalow suggère également un rôle potentiel de la TEP comme moyen diagnostique et de surveillance non invasif des AGC [25]. Dans une étude portant sur 11 patients atteints de MH (n = 6) et de pseudopolyarthrite rhizomélique (PPR ; n = 5), Blockmans retrouve une hypercaptation très significative du 18 FDG (p < 0,001) au niveau des gros vaisseaux cervicothoraciques (aorte, artères sous-clavières et carotides) chez 8 patients sur 11 [26].…”

Diagnosis and Treatment of Giant Cell Arteritis (Temporal Arteritis) – Past, Current and Future Aspects

“…Moreover, no definite concordance between MRI and acute phase assessed by CRP has been established (86). Finally, to few studies have specifically addressed the suitability of MRI diagnosing arteritis in the temporal arteries (202). Although disputed (201) , MRI appears as a favorable means to detect large vessel vasculitis, in any case when abnormalities such as vessel narrowing or obliteration have developed.…”