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

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.

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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.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Ingo Einspieler.

Additional information

Ingo Einspieler and Klaus Thürmel contributed equally to this work.

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Einspieler, I., Thürmel, K., Pyka, T. et al. Imaging large vessel vasculitis with fully integrated PET/MRI: a pilot study. Eur J Nucl Med Mol Imaging 42, 1012–1024 (2015). https://doi.org/10.1007/s00259-015-3007-8

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  • DOI: https://doi.org/10.1007/s00259-015-3007-8

Keywords

  • PET
  • MRI
  • PET/MRI
  • Vasculitis
  • Large vessel vasculitis
  • Inflammation