Review
Role of FDG-PET and PET/CT in the diagnosis and management of vasculitis

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Abstract

Purpose

to investigate the role of FDG-PET and PET/CT in the evaluation of vasculitis.

Materials and methods

a systematic revision of the papers published in PubMed/Medline until December 2009 was done.

Results

FDG-PET and PET/CT have been proven to be valuable in the diagnosis of large-vessel vasculitis, especially giant cells arteritis with sensitivity values ranging 77% to 92%, and specificity values ranging 89% to 100%. In particular, FDG-PET/CT has demonstrated the potential to non-invasively diagnose the onset of the vasculitis earlier than traditional anatomical imaging techniques, thus enabling prompt treatment. False positive results mainly occur in the differential diagnosis between vasculitis and atherosclerotic vessels in elderly patients. Another area where FDG-PET/CT is gaining wider acceptance is in monitoring response to therapy; it can reliably detect the earliest changes of disease improvement post-therapy, and persistent activity is an indicator of non-responders to therapy. A few data have been reported about medium/small vessel vasculitis.

Discussion

FDG-PET and PET/CT have proven utility: (a) in the initial diagnosis of patients suspected of having vasculitis particularly in those who present with non-specific symptoms; (b) in the identification of areas of increased FDG uptake in which a biopsy should be done for obtaining a diagnosis; (c) in evaluating the extent of the disease; (d) in assessing response to treatment.

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.

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