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

  • J. MellerEmail author
  • F. Strutz
  • U. Siefker
  • A. Scheel
  • C. O. Sahlmann
  • K. Lehmann
  • M. Conrad
  • R. Vosshenrich
Short Communication

Abstract

The aim of this prospective study was to compare fluorine-18 fluorodeoxyglucose ([18F]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 [18F]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 [18F]FDG imaging were compared with the results of MRI at initial evaluation and during follow-up and with the clinical findings. At baseline, abnormal [18F]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 [18F]FDG uptake correlated with clinical improvement and with normalisation of the laboratory findings. All except one of the patients with positive aortic [18F]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 [18F]FDG PET is valuable in the primary diagnosis of early aortitis. The results of [18F]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 [18F]FDG PET was more reliable than MRI in monitoring disease activity during immunosuppressive therapy.

Keywords

[18F]FDG PET Hybrid camera MRI MRA Aortitis 

References

  1. 1.
    Levine SM, Hellmann DB. Giant cell arteritis. Curr Opin Rheumatol 2002; 14:3–10.Google Scholar
  2. 2.
    Evans JM, Bowles CA, Bjornsson J, Mullany CJ, Hunder GG. Thoracic aortic aneurysm and rupture in giant cell arteritis. A descriptive study of 41 cases. Arthritis Rheum 1994; 37:1539–1547.Google Scholar
  3. 3.
    Kerr GS. Takayasu's arteritis. Rheum Dis Clin North Am 1995; 21:1041–1058.Google Scholar
  4. 4.
    Gravanis MB. Giant cell arteritis and Takayasu aortitis: morphologic, pathogenetic and etiologic factors. Int J Cardiol 2000; 75 (Suppl 1):S21–S33.Google Scholar
  5. 5.
    Sharma BK, Iliskovic NS, Singal PK. Takayasu's arteritis may be underdiagnosed in North America. Can J Cardiol 1995; 11:311–316.Google Scholar
  6. 6.
    Matsunaga N, Hayashi K, Sakamoto I, Matsuoka Y, Ogawa Y, Honjo K, Takano K. Takayasu arteritis: MR manifestations and diagnosis of acute and chronic phase. Magn Reson Imaging 1998; 8:406–414.Google Scholar
  7. 7.
    Hunder GG. Classification/diagnostic criteria for GCA/PMR. Clin Exp Rheumatol 2000; 18 (4 Suppl 20):S4–S5.Google Scholar
  8. 8.
    Meller J, Altenvoerde G, Munzel U, Jauho A, Behe M, Gratz S, Luig H, Becker W. Fever of unknown origin: prospective comparison of [18F]FDG imaging with a double-head coincidence camera and galium-67 citrate SPET. Eur J Nucl Med 2000; 27:1617–1625.Google Scholar
  9. 9.
    Luig H, Eschner W, Bähre M, Voth E, Nolte G. Eine iterative Strategie zur Bestimmung der Quellverteilung bei der Einzelphotonen Tomographie mit einer rotierenden Gammakamera (SPECT). Nuklearmedizin 1988; 27:140–146.Google Scholar
  10. 10.
    Hudson HM, Larkin RS. Accelerated image reconstruction using ordered subsets of projection data. IEEE Trans Med Imaging 1994; 13:601–609.Google Scholar
  11. 11.
    Turlakow A, Yeung HW, Pui J, Macapinlac H, Liebovitz E, Rusch V, Goy A, Larson SM. Fludeoxyglucose positron emission tomography in the diagnosis of giant cell arteritis. Arch Intern Med 2001; 161:1003–1007.Google Scholar
  12. 12.
    Blockmans D, Maes A, Stroobants S, Nuyts J, Bormans G, Knockaert D, Bobbaers H, Mortelmans L. New arguments for a vasculitic nature of polymyalgia rheumatica using positron emission tomography. Rheumatology (Oxford) 1999; 38:444–447.Google Scholar
  13. 13.
    Hara M, Goodman PC, Leder RA FDG-PET finding in early-phase Takayasu arteritis. J Comput Assist Tomogr 1999; 23:16–18.Google Scholar
  14. 14.
    Derdelinckx I, Maes A, Bogaert J, Mortelmans L, Blockmans D. Positron emission tomography scan in the diagnosis and follow-up of aortitis of the thoracic aorta. Acta Cardiol 2000; 55:193–195.Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • J. Meller
    • 1
    Email author
  • F. Strutz
    • 2
  • U. Siefker
    • 1
  • A. Scheel
    • 2
  • C. O. Sahlmann
    • 1
  • K. Lehmann
    • 1
  • M. Conrad
    • 1
  • R. Vosshenrich
    • 3
  1. 1.Department of Nuclear MedicineGeorg August UniversityGöttingenGermany
  2. 2.Department of Nephrology and RheumatologyGeorg August UniversityGöttingenGermany
  3. 3.Department of RadiologyGeorg August UniversityGöttingenGermany

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