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Imaging large vessel vasculitis with fully integrated PET/MRI: a pilot study

  • Ingo Einspieler
  • Klaus Thürmel
  • Thomas Pyka
  • Matthias Eiber
  • Sabine Wolfram
  • Philipp Moog
  • Christian Reeps
  • Markus Essler
Original Article

Abstract

Purpose

The aim of this study was to evaluate the feasibility of hybrid [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/MRI in patients with large vessel vasculitis (LVV) by comparing visual and quantitative parameters to that of PET/CT. Furthermore, the value of PET/MRI in disease activity and extent of LVV was assessed.

Methods

A total of 16 [18F]FDG PET/MRI and 12 [18F]-FDG PET/CT examinations were performed in 12 patients with LVV. MRI of the vessel wall by T1-weighted and T2-weighted sequences was used for anatomical localization of FDG uptake and identification of morphological changes associated with LVV. In addition, contrast-enhanced (CE) magnetic resonance angiography (MRA) was performed. The vascular FDG uptake in the vasculitis group was compared to a reference group of 16 patients using a four-point visual score. Visual scores and quantitative parameters [maximum standardized uptake value (SUVmax) and target to background ratio (TBR)] were compared between PET/MRI and PET/CT. Furthermore, correlations between C-reactive protein (CRP) and quantitative PET results, as well the extent of vasculitis in PET, MRI/CE-MRA and combined PET/MRI, were analysed.

Results

TBRs, SUVmax values and visual scores correlated well between PET/MRI and PET/CT (r = 0.92, r = 0.91; r = 0.84, p < 0.05). There was no significant difference between both modalities concerning SUVmax measurements and visual scores. In PET/MRI, PET alone revealed abnormal FDG uptake in 86 vascular regions. MRI/CE-MRA indicated 49 vessel segments with morphological changes related to vasculitis, leading to a total number of 95 vasculitis regions in combination with PET. Strong and significant correlations between CRP and disease extent in PET alone (r = 0.75, p = 0.0067) and PET/MRI (r = 0.92, p < 0.0001) in contrast to MRI/CE-MRA only were observed. Regarding disease activity, no significant correlations were seen between quantitative PET results and CRP, although there was a trend towards significance (r = 0.55, p = 0.0651). PET/MRI also showed active LVV in 15/16 examinations.

Conclusion

Hybrid PET/MRI is feasible in LVV and holds promise for precisely determining disease extent and disease activity.

Keywords

PET MRI PET/MRI Vasculitis Large vessel vasculitis Inflammation 

Notes

Acknowledgments

We thank the entire PET/MRI and PET/CT teams for assistance.

Compliance with ethical standards

Conflicts of Interest

None.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, et al. Takayasu arteritis. Ann Intern Med 1994;120:919–29.CrossRefPubMedGoogle Scholar
  2. 2.
    Nuenninghoff DM, Hunder GG, Christianson TJ, McClelland RL, Matteson EL. Incidence and predictors of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis: a population-based study over 50 years. Arthritis Rheum 2003;48:3522–31.CrossRefPubMedGoogle Scholar
  3. 3.
    Andrews J, Al-Nahhas A, Pennell DJ, Hossain MS, Davies KA, Haskard DO, et al. Non-invasive imaging in the diagnosis and management of Takayasu’s arteritis. Ann Rheum Dis 2004;63:995–1000.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Pipitone N, Versari A, Salvarani C. Role of imaging studies in the diagnosis and follow-up of large-vessel vasculitis: an update. Rheumatology 2008;47:403–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Choe YH, Han BK, Koh EM, Do YS, Lee WR. Takayasu’s arteritis: assessment of disease activity with contrast-enhanced MR imaging. AJR Am J Roentgenol 2000;175:505–11.CrossRefPubMedGoogle Scholar
  6. 6.
    Oehmigen M, Ziegler S, Jakoby BW, Georgi JC, Paulus DH, Quick HH. Radiotracer dose reduction in integrated PET/MR: implications from National Electrical Manufacturers Association phantom studies. J Nucl Med 2014;55:1361–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Meller J, Strutz F, Siefker U, Scheel A, Sahlmann CO, Lehmann K, et al. Early diagnosis and follow-up of aortitis with [(18)F]FDG PET and MRI. Eur J Nucl Med Mol Imaging 2003;30:730–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Scheel AK, Meller J, Vosshenrich R, Kohlhoff E, Siefker U, Müller GA, et al. Diagnosis and follow up of aortitis in the elderly. Ann Rheum Dis 2004;63:1507–10.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990;33:1129–34.CrossRefPubMedGoogle Scholar
  10. 10.
    Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990;33:1122–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Delso G, Fürst S, Jakoby B, Ladebeck R, Ganter C, Nekolla SG, et al. Performance measurements of the Siemens mMR integrated whole-body PET/MR scanner. J Nucl Med 2011;52:1914–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Samarin A, Burger C, Wollenweber SD, Crook DW, Burger IA, Schmid DT, et al. PET/MR imaging of bone lesions—implications for PET quantification from imperfect attenuation correction. Eur J Nucl Med Mol Imaging 2012;39:1154–60.CrossRefPubMedGoogle Scholar
  13. 13.
    Walter MA, Melzer RA, Schindler C, Müller-Brand J, Tyndall A, Nitzsche EU. The value of [18F]FDG-PET in the diagnosis of large-vessel vasculitis and the assessment of activity and extent of disease. Eur J Nucl Med Mol Imaging 2005;32:674–81.CrossRefPubMedGoogle Scholar
  14. 14.
    Rudd JH, Warburton EA, Fryer TD, Jones HA, Clark JC, Antoun N, et al. Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation 2002;105:2708–11.CrossRefPubMedGoogle Scholar
  15. 15.
    Yun M, Yeh D, Araujo LI, Jang S, Newberg A, Alavi A. F-18 FDG uptake in the large arteries: a new observation. Clin Nucl Med 2001;26:314–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Henes JC, Müller M, Krieger J, Balletshofer B, Pfannenberg AC, Kanz L, et al. [18F] FDG-PET/CT as a new and sensitive imaging method for the diagnosis of large vessel vasculitis. Clin Exp Rheumatol 2008;26:S47–52.PubMedGoogle Scholar
  17. 17.
    Hoffman GS, Ahmed AE. Surrogate markers of disease activity in patients with Takayasu arteritis. A preliminary report from The International Network for the Study of the Systemic Vasculitides (INSSYS). Int J Cardiol 1998;66 Suppl 1:S191–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Fuchs M, Briel M, Daikeler T, Walker UA, Rasch H, Berg S, et al. The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging 2012;39:344–53.CrossRefPubMedGoogle Scholar
  19. 19.
    Moosig F, Czech N, Mehl C, Henze E, Zeuner RA, Kneba M, et al. Correlation between 18-fluorodeoxyglucose accumulation in large vessels and serological markers of inflammation in polymyalgia rheumatica: a quantitative PET study. Ann Rheum Dis 2004;63:870–3.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Belhocine T, Blockmans D, Hustinx R, Vandevivere J, Mortelmans L. Imaging of large vessel vasculitis with (18)FDG PET: illusion or reality? A critical review of the literature data. Eur J Nucl Med Mol Imaging 2003;30:1305–13.CrossRefPubMedGoogle Scholar
  21. 21.
    Blockmans D, de Ceuninck L, Vanderschueren S, Knockaert D, Mortelmans L, Bobbaers H. Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients. Arthritis Rheum 2006;55:131–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Arnaud L, Haroche J, Malek Z, Archambaud F, Gambotti L, Grimon G, et al. Is (18)F-fluorodeoxyglucose positron emission tomography scanning a reliable way to assess disease activity in Takayasu arteritis? Arthritis Rheum 2009;60:1193–200.CrossRefPubMedGoogle Scholar
  23. 23.
    Both M, Ahmadi-Simab K, Reuter M, Dourvos O, Fritzer E, Ullrich S, et al. MRI and FDG-PET in the assessment of inflammatory aortic arch syndrome in complicated courses of giant cell arteritis. Ann Rheum Dis 2008;67:1030–3.CrossRefPubMedGoogle Scholar
  24. 24.
    Lee KH, Cho A, Choi YJ, Lee SW, Ha YJ, Jung SJ, et al. The role of (18) F-fluorodeoxyglucose-positron emission tomography in the assessment of disease activity in patients with takayasu arteritis. Arthritis Rheum 2012;64:866–75.CrossRefPubMedGoogle Scholar
  25. 25.
    Zerizer I, Tan K, Khan S, Barwick T, Marzola MC, Rubello D, et al. Role of FDG-PET and PET/CT in the diagnosis and management of vasculitis. Eur J Radiol 2010;73:504–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Blockmans D, Bley T, Schmidt W. Imaging for large-vessel vasculitis. Curr Opin Rheumatol 2009;21:19–28.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ingo Einspieler
    • 1
  • Klaus Thürmel
    • 2
  • Thomas Pyka
    • 1
  • Matthias Eiber
    • 1
  • Sabine Wolfram
    • 2
  • Philipp Moog
    • 2
  • Christian Reeps
    • 3
  • Markus Essler
    • 4
  1. 1.Department of Nuclear MedicineTechnische Universität München, Klinikum rechts der IsarMunichGermany
  2. 2.Department of NephrologyTechnische Universität München, Klinikum rechts der IsarMunichGermany
  3. 3.Department of Vascular Surgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  4. 4.Department of Nuclear Medicine, Universitätsklinikum BonnRheinische Friedrich-Wilhelms-UniversitätBonnGermany

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