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Annals of Nuclear Medicine

, Volume 27, Issue 10, pp 907–915 | Cite as

Integration of 2-deoxy-2-[18F] fluoro-d-glucose PET/CT into clinical management of patients with Wegener’s granulomatosis

  • Ozlem OzmenEmail author
  • Ebru Tatci
  • Atila Gokcek
  • Deniz Koksal
  • Yeliz Dadali
  • Esra Ozaydin
  • Nuri Arslan
Original Article

Abstract

Objective

Wegener’s granulomatosis (WG) is a rare disorder characterized by granulomatous necrotizing vasculitis which mainly affects small- and medium-sized vessels. While the classical triad of involvement is upper and lower respiratory system and glomerulonephritis, WG may involve any organ or system in the body. The aim of our study was to investigate the role of positron emission tomography/computerized tomography (PET/CT) both in the initial evaluation and follow-up of patients with WG.

Methods

We retrospectively evaluated PET/CT data from 13 patients (6 males; 7 females) with a mean age of 45 ± 12.4 years (range 28–63) who underwent either initial evaluation (n = 12) or response evaluation (n = 2) by conventional imaging methods and FDG with PET/CT. PET/CT images were both visually and quantitatively evaluated. The demographic data, clinical and laboratory findings of each patient were also recorded from the hospital files.

Results

Lung (n = 13), parapharyngeal space (n = 8), nose (n = 8), and ear (n = 3) were the most common disease sites detected on PET/CT. The entire initial evaluation patients had either solitary or multiple pulmonary nodular/mass lesions with marked increased FDG uptake (mean SUVmax 12 ± 4, range 3.53–19.51) on PET/CT. There was no significant pathological FDG uptake in patients consistent with complete treatment response after appropriate immunosuppressive therapy. PET/CT clearly demonstrated unexpected disease sites besides the respiratory system, with WG involvement except kidneys. Possibly due to physiological urinary excretion of FDG, urine analysis, BUN and creatinine levels were accepted still the best way for diagnosis of renal involvement.

Conclusion

FDG with PET/CT is a valuable tool in the management of patients with WG for a more accurate clinical evaluation regarding disease extension and treatment response.

Keywords

PET/CT Wegener’s granulomatosis Vasculitis 

Notes

Acknowledgments

The authors wish to thank Dr. Aysenaz Ozcan, Dr. Belgin Samurkasoglu, Dr. Nermin Capan, Dr. Nilgun Kalac, Dr. Sema Canbakan, Dr. Sukran Atikcan, Dr. Yurdanur Erdogan for referring their patients to our department and cooperation. The abstract of the manuscript has also been accepted to be presented at 26th Annual Congress of the EANM in October 2013.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Woywodt A, Matteson EL. Wegener’s granulomatosis—probing the untold past of the man behind the eponym. Rheumatology (Oxford). 2006;45(10):1303–6.CrossRefGoogle Scholar
  2. 2.
    Frankel SK, Cosgrove GP, Fischer A, Meehan RT, Brown KK. Update in the diagnosis and management of pulmonary vasculitis. Chest. 2006;129(2):452–65.PubMedCrossRefGoogle Scholar
  3. 3.
    Fries JF, Hunder GG, Bloch DA, Michel BA, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis. Summary. Arthritis Rheum. 1990;33(8):1135–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Hagen EC, Daha MR, Hermans J, Andrassy K, Csernok E, Gaskin G, et al. Diagnostic value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis. EC/BCR Project for ANCA Assay Standardization. Kidney Int. 1998;53(3):743–53.PubMedCrossRefGoogle Scholar
  5. 5.
    Choi HK, Liu S, Merkel PA, Colditz GA, Niles JL. Diagnostic performance of antineutrophil cytoplasmic antibody tests for idiopathic vasculitides: metaanalysis with a focus on antimyeloperoxidase antibodies. J Rheumatol. 2001;28(7):1584–90.PubMedGoogle Scholar
  6. 6.
    Pretorius ES, Stone JH, Hellmann DB, Fishman EK. Wegener’s granulomatosis: spectrum of CT findings in diagnosis, disease progression, and response to therapy. Crit Rev Diagn Imaging. 2000;41(4):279–313.PubMedGoogle Scholar
  7. 7.
    Seo P, Stone JH. The antineutrophil cytoplasmic antibody-associated vasculitides. Am J Med. 2004;117(1):39–50.PubMedCrossRefGoogle Scholar
  8. 8.
    Frankel SK, Cosgrove GP, Fischer A, Meehan RT, Brown KK. Update in the diagnosis and management of pulmonary vasculitis. Chest. 2006;129(2):452–65.PubMedCrossRefGoogle Scholar
  9. 9.
    Levin A, Kasem S, Mader R, Naparstek Y, Friedman G, Ben-Yehuda A. Wegener granulomatosis with back pain, periaortitis, and dural inflammation developing while receiving monthly cyclophosphamide. J Clin Rheumatol. 2006;12(6):294–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Ito K, Minamimoto R, Yamashita H, Yoshida S, Morooka M, Okasaki M. Evaluation of Wegener’s granulomatosis using 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Ann Nucl Med. 2012.Google Scholar
  11. 11.
    Leavitt RY, Fauci AS, Bloch DA, Michel BA, Hunder GG, Arend WP. The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum. 1990;33(8):1101–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Bleeker-Rovers CP, Bredie SJ, van der Meer JW, Corstens FH, Oyen WJ. F-18-fluorodeoxyglucose positron emission tomography in diagnosis and follow-up of patients with different types of vasculitis. Neth J Med. 2003;61(10):323–9.PubMedGoogle 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(6):674–81.PubMedCrossRefGoogle Scholar
  14. 14.
    Fuchs M, Briel M, Daikeler T, Walker UA, Rasch H, Berg S. The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging. 2012;39(2):344–53.PubMedCrossRefGoogle Scholar
  15. 15.
    Beggs AD, Hain SF. F-18 FDG-positron emission tomographic scanning and Wegener’s granulomatosis. Clin Nucl Med. 2002;27(10):705–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Lapraik C, Watts R, Bacon P, Carruthers D, Chakravarty K, D’Cruz D. BSR and BHPR guidelines for the management of adults with ANCA associated vasculitis. Rheumatology (Oxford). 2007;46(10):1615–6.CrossRefGoogle Scholar
  17. 17.
    Fries JF, Hunder GG, Bloch DA, Michel BA, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis. Summary. Arthritis Rheum. 1990;33(8):1135–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Maranhão AS, Chen VG, Rossini BA, Testa JR, Penido Nde O. Mastoiditis and facial paralysis as initial manifestations of Wegener’s granulomatosis. Braz J Otorhinolaryngol. 2012;78(2):80–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, et al. Nomenclature of systemic vasculitides: proposal of an international consensus conference. Arthritis Rheum. 1994;37(2):187–92.PubMedCrossRefGoogle Scholar
  20. 20.
    Blockmans D, Baeyens H, Van Loon R, Lauwers G, Bobbaers H. Periaortitis and aortic dissection due to Wegener’s granulomatosis. Clin Rheumatol. 2000;19(2):161–4.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2013

Authors and Affiliations

  • Ozlem Ozmen
    • 1
    Email author
  • Ebru Tatci
    • 1
  • Atila Gokcek
    • 2
  • Deniz Koksal
    • 3
  • Yeliz Dadali
    • 2
  • Esra Ozaydin
    • 4
  • Nuri Arslan
    • 5
  1. 1.Department of Nuclear MedicineAtaturk Chest Diseases and Thoracic Surgery Training and Research HospitalKecioren, AnkaraTurkey
  2. 2.Department of RadiologyAtaturk Chest Diseases and Thoracic Surgery Training and Research HospitalAnkaraTurkey
  3. 3.Department of Chest DiseasesAtaturk Chest Diseases and Thoracic Surgery Training and Research HospitalAnkaraTurkey
  4. 4.Department of PathologyAtaturk Chest Diseases and Thoracic Surgery Training and Research HospitalAnkaraTurkey
  5. 5.Department of Nuclear MedicineGulhane Military Medical Academy and Medical FacultyAnkaraTurkey

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