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18F-FDG PET reveals unique features of large vessel inflammation in patients with Takayasu’s arteritis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The object of this study was to assess whether 18F-fluorodeoxyglucose PET/CT (FDG PET/CT) provides novel information in patients with Takayasu’s arteritis (TA) in addition to that provided by current activity assessment, to analyse the effects of possible confounders, such as arterial grafts, and to verify whether PET/CT could be informative in lesions <4 mm thick.

Methods

We studied 30 patients with TA, evaluated from October 2010 to April 2014 by both PET/CT and magnetic resonance imaging (MRI). All arterial lesions were evaluated by PET both qualitatively (positive/negative) and semiquantitatively (maximum standardized uptake value, SUVmax), and the thickness of lesions in the MRI field of view was evaluated. In a per-patient analysis, the relationships between the PET data and acute-phase reactants and NIH criteria for active TA were evaluated. In a per-lesion analysis, the relationships between the PET features of each lesion and MRI morphological data were evaluated. The effects of the presence of arterial grafts were also evaluated.

Results

Increased FDG uptake was seen in 16 of 30 patients (53%) and in 46 of 177 vascular lesions (26%). Significant periprosthetic FDG uptake was seen in 6 of 7 patients (86%) with previous vascular surgery and in 10 of 11 of grafts (91%). Graft-associated uptake influenced the PET results in three patients (10%) and the SUVmax values in five patients (17%). Of 39 lesions with significant FDG uptake, 15 (38%) were <4 mm thick. Lesion thickness was correlated with lesion SUVmax in FDG-avid lesions only. FDG arterial uptake was not associated with systemic inflammation or NIH criteria.

Conclusions

PET/CT reveals unique and fundamental features of arterial involvement in TA. PET/CT may be useful in the assessment of local inflammatory and vascular remodelling events independent of systemic inflammation during follow-up, even in lesions in which the arterial wall is <4 mm. The presence of arterial grafts is a potential confounder. Prospective studies are required to correlate PET findings with relevant clinical outcomes.

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Acknowledgments

This work was supported by the Italian Ministry of Health, Ricerca Finalizzata: RF-2013-02358715.

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    Authors and Affiliations

    1. Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

      Elena Incerti, Federico Fallanca, Pierpaolo Alongi, Luigi Gianolli & Maria Picchio

    2. Vita-Salute San Raffaele University, Milan, Italy

      Enrico Tombetti, Elisabetta Tombolini, Silvia Sartorelli, Maria Grazia Sabbadini, Francesco De Cobelli & Angelo A. Manfredi

    3. Unit of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy

      Enrico Tombetti, Elena M. Baldissera, Silvia Sartorelli, Maria Grazia Sabbadini & Angelo A. Manfredi

    4. Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy

      Maurizio Papa & Francesco De Cobelli

    5. Vascular Science and Rheumatology, Imperial College London and Imperial College Healthcare NHS Trust, London, UK

      Justin C. Mason

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    1. Elena Incerti
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    Correspondence to Maria Picchio.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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

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    E. Incerti and E. Tombetti contributed equally to this work.

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    Incerti, E., Tombetti, E., Fallanca, F. et al. 18F-FDG PET reveals unique features of large vessel inflammation in patients with Takayasu’s arteritis. Eur J Nucl Med Mol Imaging 44, 1109–1118 (2017). https://doi.org/10.1007/s00259-017-3639-y

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