Journal of Nuclear Cardiology

, Volume 21, Issue 5, pp 993–1000 | Cite as

F-18 FDG PET/CT in the evaluation of Takayasu arteritis: An experience from the tropics

  • Sampath Santhosh
  • Bhagwant Rai Mittal
  • Shankaramurthy Gayana
  • Anish Bhattacharya
  • Aman Sharma
  • Sanjay Jain
Original Article



To evaluate the performance parameters of FDG PET/CT in patients with Takayasu arteritis at diagnosis and during immunosuppression.


Retrospective analysis of 60 FDG PET/CT studies in 51 patients was performed (17 scans at diagnosis out of which 4 had follow-up scans also and 43 scans on immunosuppression). The degree of FDG uptake in the vessels was assessed visually using a 4-point scale and maximum standardized uptake value (SUVmax), SUVratio, extent of vasculitis and association with ESR were calculated.


PET/CT was positive for active vasculitis in all 17 patients at diagnosis. The mean SUVmax and mean SUV ratio of the active areas were 5.1 ± 3.0 and 3.2 ± 1.9, respectively. On immunosuppression, PET scan was positive for active vasculitis in 14/43 (32.5%) scans. The mean SUVmax and mean SUVratio of the active areas were 1.7 ± 2.1 and 0.95 ± 1.2, respectively. There was significant difference between the mean SUVmax and mean SUVratio at diagnosis and on immunosuppression, respectively (P < .01). The median number of vascular segments in each uptake grade group was also statistically different (P < .01) between scans at diagnosis and on immunosuppression. The median ESR level in PET positive scans was 29 mm/hour (2-53), whereas in PET negative scans was 35.5 mm/hour (6-50) and the difference was not statistically significant.


FDG PET/CT showed good sensitivity to detect active vasculitis at diagnosis and during immunosuppression. The change in SUVmax between the successive FDG PET/CT scans may give an objective assessment of response to immunosuppression.


Takayasu arteritis vasculitis immunosupression FDG PET/CT 


Conflict of interest

The authors declare that they have no conflict of interest.


The authors have no direct or indirect commercial/financial incentive associated with publishing the article. No funding has been received for this work from any of the organizations.


  1. 1.
    Langford CA, Fauci AS. The vasculitis syndromes. In: Fauci Longo, Hauser Kasper, Loscalzo Jameson, editors. Harrison’s principles of internal medicine. 18th ed. New York: McGraw Hill; 2012. p. 2116.Google Scholar
  2. 2.
    Hacker M. Monitoring anti-inflammatory therapies in patients with atherosclerosis: FDG PET emerges as the method of choice. Eur J Nucl Med Mol Imaging 2012;39:396-8.PubMedCrossRefGoogle Scholar
  3. 3.
    Wu YW, Kao HL, Huang CL, Chen MF, Lin LY, Wang YC et al. The effects of 3-month atorvastatin therapy on arterial inflammation, calcification, abdominal adipose tissue and circulating biomarkers. Eur J Nucl Med Mol Imaging 2012;39:399-407.PubMedCrossRefGoogle Scholar
  4. 4.
    Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworth SM, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990;33:1129-34.PubMedCrossRefGoogle Scholar
  5. 5.
    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;61:323-9.PubMedGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    Lee SG, Ryu JS, Kim HO, Oh JS, Kim YG, Lee CK, et al. Evaluation of disease activity using F-18 FDG PET-CT in patients with Takayasu arteritis. Clin Nucl Med 2009;34:749-52.PubMedCrossRefGoogle Scholar
  8. 8.
    Kobayashi Y, Ishii K, Oda K, Nariai T, Tanaka Y, Ishiwata K, et al. Aortic wall inflammation due to Takayasu arteritis imaged with 18F-FDG PET coregistered with enhanced CT. J Nucl Med 2005;46:917-22.PubMedGoogle Scholar
  9. 9.
    Webb M, Chambers A, AL-Nahhas A, Mason JC, Maudlin L, Rahman L, et al. The role of 18F-FDG PET in characterising disease activity in Takayasu arteritis. Eur J Nucl Med Mol Imaging 2004;31:627-34.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    Vanoli M, Daina E, Salvarani C, Sabbadini MG, Rossi C, Bacchiani G, et al. Takayasu’s arteritis: A study of 104 Italian patients. Arthritis Rheum 2005;53:100-7.PubMedCrossRefGoogle Scholar
  13. 13.
    Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE. Takayasu’s arteritis. Clinical study of 107 cases. Am Heart J 1977;93:94-103.PubMedCrossRefGoogle Scholar
  14. 14.
    Park YB, Hong SK, Choi KJ, Sohn DW, Oh BH, Lee MM, et al. Takayasu arteritis in Korea: Clinical and angiographic features. Heart Vessels suppl 1992;7:55-9.PubMedCrossRefGoogle Scholar
  15. 15.
    Sharma BK, Sagar S, Singh AP, Suri S. Takayasu arteritis in India. Heart Vessels 1992;7:37-43.CrossRefGoogle Scholar
  16. 16.
    Maksimowicz-McKinnon K, Clark TM, Hoffman GS. Limitations of therapy and a guarded prognosis in an American cohort of Takayasu arteritis patients. Arthritis Rheum 2007;56:1000-9.PubMedCrossRefGoogle Scholar
  17. 17.
    Zheng D, Fan D, Liu L. Takayasu arteritis in China: A report of 530 cases. Heart Vessels 1992;7:32-6.CrossRefGoogle Scholar
  18. 18.
    Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, et al. Takayasu arteritis. Ann Intern Med 1994;120:919-29.PubMedCrossRefGoogle Scholar
  19. 19.
    Fuchs M, Briel M, Daikeler T, 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.PubMedCrossRefGoogle Scholar
  20. 20.
    Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: A review. J Clin Pathol 2002;55:481-6.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Dhawan V, Mahajan N, Jain S. Role of C-C chemokines in Takayasu’s arteritis disease. Int J Cardiol 2006;112:105-11.PubMedCrossRefGoogle Scholar
  22. 22.
    Mahajan N, Dhawan V, Malik S, Jain S. Implication of oxidative stress and its correlation with activity of matrix metalloproteinases in patients with Takayasu’s arteritis disease. Int J Cardiol 2010;145:286-8.PubMedCrossRefGoogle Scholar
  23. 23.
    Mahajan N, Dhawan V, Malik S, Jain S. Serum levels of soluble receptor for advanced glycation end products (sRAGE) in Takayasu’s arteritis. Int J Cardiol 2010;3:589-91.CrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2014

Authors and Affiliations

  • Sampath Santhosh
    • 1
  • Bhagwant Rai Mittal
    • 1
  • Shankaramurthy Gayana
    • 1
  • Anish Bhattacharya
    • 1
  • Aman Sharma
    • 2
  • Sanjay Jain
    • 2
  1. 1.Department of Nuclear Medicine & PETPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of Internal MedicinePostgraduate Institute of Medical Education and ResearchChandigarhIndia

Personalised recommendations