ReviewRole of FDG-PET and PET/CT in the diagnosis and management of vasculitis
Section snippets
Vasculitis and its classification
Vasculitis is an inflammatory condition of the blood vessels, which affects both veins and arteries, characterized by a leukocytic infiltration of the vessel wall with reactive destruction of mural structures and surrounding tissues leading to infarction. Vasculitis can be classified according to aetiology or location of the affected vessels but more commonly it is classified according to the caliber of the vessels involved.
The Chapel-Hill consensus conference in 1992 defined vasculitides with
2-Deoxy-2-[18F]fluoro-d-glucose positron emission tomography (18F-FDG-PET)
FDG is a glucose analogue labelled with a fluorine-18 molecule, which is a positron emitter used in clinical imaging. It is taken up into the cells via the same mechanism as glucose through the Glut-1 transporter mechanism. It then undergoes phosphorylation via the hexokinase pathway into FDG-6-phosphate. Unlike normal glucose, this does not undergo any further glycolysis due to the lack of 2′ hydroxyl group (–OH), thus it cannot move out of the cells before radioactive decays. As a result, the
The role of FDG-PET in large-vessel vasculitides
The common large-vessel vasculitides are giant cell arteritis (GCA) and TA. GCA is the most common type particularly affecting the elderly female population with an incidence of 20 per 100,000 population [11]. Typically the patients report headache, jaw claudication, visual disturbances, and in approximately half of cases, symptoms of polymyalgia rheumatica [11]. In most cases the diagnosis is made based on the history, clinical presentation and temporal artery biopsy which demonstrates the
Limitations of PET/CT
There are several limitations of FDG-PET which one must be aware of. FDG-PET cannot reliably be used to diagnose or monitor inflammation of the temporal artery due to the limited spatial resolution of PET and thus PET cannot replace the invasive biopsy. This is highlighted by a study performed to determine the role of FDG-PET as a non-invasive technique for the diagnosis of temporal arteritis in 22 patients with a clinical diagnosis of GCA, in which FDG-PET failed to demonstrate increased
The role of FDG-PET/CT in medium/small vessel vasculitis
The role of FDG-PET in the diagnosis of small vessel vasculitis is less well defined as there are no systematic studies in the literature. It has been suggested that vasculitis of medium and small vessels (especially in Churg-Strauss syndrome, Wegener's granulomatosis, and panarteritis nodosa) is detected only if large vessels are also involved or if there is associated damage of adjacent tissues, again likely due to limited spatial resolution [14], [22], [42].
A few published case reports have
Conclusion
We can conclude that there is sufficient evidence in the literature to suggest a role for FDG-PET/CT in the following situation:
- (1)
In the initial diagnosis of patients suspected of having vasculitis particularly in those who present with non-specific symptoms and PUO. An early diagnosis enables prompt treatment to be instituted and possibly prevents life-threatening complications.
- (2)
To identify areas of increased uptake that can be used to obtain a biopsy that yields a diagnosis.
- (3)
To evaluate the
Conflict of interest
All the authors declare that they have no conflict of interest with the above article submitted to EJR.
References (43)
- et al.
Polymyalgia rheumatica and giant-cell arteritis
Lancet
(2008) - et al.
Fluorine 18 fluorodeoxyglucose positron emission tomography in the diagnosis and follow-up of three patients with vasculitis
Am J Med
(2004) - et al.
Clinical presentation and vascular imaging in giant cell arteritis of the femoropopliteal and tibioperoneal arteries. Analysis of four cases
J Vasc Surg
(2006) - et al.
Cardiovascular infection and inflammation
Semin Nucl Med
(2009) - et al.
Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch
Am J Med
(2000) - et al.
Nomenclature of systemic vasculitides. Proposal of an international consensus conference
Arthritis Rheum
(1994) - et al.
The American College of Rheumatology 1990 criteria for the classification of vasculitis. Summary
Arthritis Rheum
(1990) - et al.
18F-FDG PET and PET/CT in fever of unknown origin
J Nucl Med
(2007) - et al.
Molecular imaging of Takayasu's arteritis and other large-vessel vasculitis with 18F-FDG PET
Nucl Med Commun
(2006) - et al.
Management of systemic vasculitis: contribution of scintigraphic imaging to evaluation of disease activity and classification
Q J Med
(1995)
Temporal 67gallium uptake is increased in temporal arteritis
Rheumatology (Oxford)
Lack of sensitivity of indium-111 mixed leukocyte scans for active disease in Takayasu's arteritis
J Rheumatol
High accumulation of fluorine-18-fluorodeoxyglucose in turpentine-induced inflammatory tissue
J Nucl Med
Autoradiographic quantification of 18F-FDG uptake in experimental soft-tissue abscesses in rats
Radiology
The respiratory burst of phagocytes
J Clin Invest
Ultrasound of proximal upper extremity arteries to increase the diagnostic yield in large-vessel giant cell arteritis
Rheumatology (Oxford)
New arguments for a vasculitic nature of polymyalgia rheumatica using positron emission tomography
Rheumatology (Oxford)
The role of 2-18F-fluoro-2-deoxy-d-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries
Rheumatology (Oxford)
Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients
Arthritis Rheum
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
The use of (18F)fluoro-deoxyglucose positron emission tomography in the assessment of large vessel vasculitis
Clin Exp Rheumatol
Cited by (106)
Thoracic Aortic Aneurysmal Disease: Comprehensive Recommendations for the Primary Care Physician
2024, Mayo Clinic Proceedings2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines
2023, Journal of Thoracic and Cardiovascular Surgery2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines
2022, Journal of the American College of CardiologyNovel tracers for molecular imaging of interstitial lung disease: A state of the art review
2022, Autoimmunity ReviewsThe yield of F<sup>18</sup> FDG PET-CT for the investigation of fever of unknown origin, compared with diagnostic CT
2021, European Journal of Internal MedicineFluoro-D-glucose (18F-FDG) PET/CT and patient effective dose
2020, Radiation Physics and Chemistry