18F-FDG PET and PET/CT examination in patients with giant cell arteritis – a practical view from a PET center


Authors: Z. Řehák 1,2;  Z. Fojtík 3;  L. Fryšáková 4;  J. Šimíková 5;  I. Kielkowská 6;  P. Němec 7;  E. Eberová 8;  Obrovská M Křivanová 3;  J. Staníček 1;  J. Eremiášová 1;  J. Vašina 1;  D. Řeháková 9;  M. Šnelerová 10;  T. Tichý 11;  L. Křen 12
Authors‘ workplace: Oddělení nukleární medicíny, centrum PET, Masarykův onkologický ústav Brno 1;  Klinika infekčních chorob FN a LF MU Brno 10;  Ústav patologie FN a LF UP Olomouc 11;  Ústav patologie FN a LF MU Brno 12;  Regionální centrum aplikované molekulární onkologie Masarykův onkologický ústav Brno, LF MU Brno 2;  Interní hematologická a onkologická klinika FN a LF MU Brno 3;  III. interní klinika FN a LF UP Olomouc 4;  Interní oddělení, revmatologická ambulance, nemocnice Kyjov 5;  Interní klinika FN Ostrava 6;  II. interní klinika FN u sv. Anny v Brně a LF MU Brno 7;  Revmatologická poradna, nemocnice s poliklinikou Karviná-Ráj 8;  Klinika interní, geriatrie a praktického lékařství FN a LF MU Brno 9
Published in: Čes. Revmatol., 22, 2014, No. 2, p. 91-98.
Category: Review Article

Overview

Giant cell arteritis (GCA) is a systemic vasculitis of large arteries, which affects older people, more frequently women. Febrile illness with elevation of nonspecific laboratory markers of inflammation (ESR, CRP) may be the first symptom of this disease. In such a condition an FDG PET (PET/CT) examination can be performed due to a wider differential diagnosis. Findings of high FDG uptake in the aorta and large arteries, especially those originating from the aortic arch, are relatively uniform and typical of GCA, even at a stage when structural changes of the arteries have not developed yet. Involvement of temporal artery can be visualized using hybrid PET/CT scanners, yet rather in isolated cases. FDG uptake in the walls of large arteries can be also used to assess the disease activity (both remission and possible relapse), furthermore, this finding correlates with laboratory evidence of disease activity (ESR, CRP). Although PET (PET/CT) examination is frequently used for primary diagnosis and monitoring of disease activity, these examinations are not considered standard. Herein, we present 4 patients using visual documentation. In these patients, PET (PET/CT) examination was used for primary diagnosis, and is compared with the CT angiography or MR angiography. In 2 patients, histological verification is presented. In 3 out of 4 patients, further course of the disease was monitored by PET examination as well.

Key words:
Giant cell arteritis, temporal arteritis, large vessel vasculitis, PET, PET/CT


Sources

1. Nesher G, Nesjet R. Giant cell arteritis and polymyalgia rheumatica, chapter 24 In Ball GV, Bridges SL. Vasculitis second edition. Oxford: University Press 2008: 305–322.

2. Hunder GC, Bloch DA, Michel BA et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis and Rheumatism 1990;33(8):1122–1128.

3. Kalamia KT, Hunder GC. Giant cell arteritis (temporal arteritis) presenting as fever of undetermined origin. Arthritis Rheum 1981; 24(11): 1414–1418.

4. Giant cell arteritis. Am J Roentgenol 2003; 81(3): 742.

5. Ferda J. CT angiografie. Praha: Galen 2004: p. 114.

6. Bley TA, Wieben O, Uhl M et al. High-resolution MRI in giant cell arteritis: imaging of the wall of the superficial temporal artery. Am J Roentgenol 2005; 184(1): 283–287.

7. Bley TA, Uhl M, Carew J, Marki M, Schmidt E, Peter HH, et al. Diagnostic value of high-resolution MR imaging in giant cell arteritis. AJNR Am J Neuroradiol 2007; 28: 1722–7.

8. Ciancio G, Brushi M, Govoni M. Ultrasonography in diagnosis and follow-up of temporal arteritis: an update. In: Challenges in Rheumatology (ed. M. Harjacek). Rijeka: InTech: 2009; 129–142.

9. Schmidt WA, Blockmans D. Use of ultrasonography and positron emission tomography in the diagnosis and assessment of large-vessel vasculitis. Curr Opin Rheumatol 2004; 17: 9–15.

10. Pipitone N, Versari A, Salvarani C. Role of imaging studies in the diagnosis and follow-up of large vesel vasculitis: an update. Rheumatology 2008; 47: 403–408.

11. Křivanová A, Adam Z, Mayer J et al. Teplota nejasné etiologie: příčiny a diagnostický postup. Vnitr Lek 2007; 53(2): 169–178.

12. Jarůšková M, Bělohlávek O. Role of FDG-PET and PET/CT in the diagnosis of prolonged fibrile states. Eur J Nucl Med Mol Imaging 2006; 33: 913–918.

13. Bleeker-Rovers CP, de Kleijn EM, Corstens FH et al. Clinical value of FDG PET in patiens with fever of unknown origin and patiens suspected of focal infection or inflammation. Eur J Nucl Med Mol Imaging 2004; 31: 29–37.

14. Blockmans D, Knockaert D, Maes A et al. Clinical value of (18F)fluoro-deoxyglucose positron emission tomography for patients with fever of unknown origin. Clin Infect Dis 2001; 32: 191–196.

15. Ferdová E, Záhlava J, Ferda J. Horečky nejasného původu, význam hybridního zobrazeni 18F-FDG-PET/CT. Ces Radiol 2008; 62(1): 23–33.

16. Řehák Z, Fojtík Z, Hofírek I. Přínos 18F-FDG PET vyšetření v diagnostice vaskulitid velkých cév u nemocných s horečkami neznámého původu. In O. Eliška, J. Spáčil, V. Štvrtinová. Angiologie 2008, trendy soudobé angiologie, Galen 2008, p. 23–30.

17. Zerizer I, Tan K, Khan S et al. Role of FDG-PET and PET/CT in the diagnosis and management of vasculitis Eur J Radiol 2010; 73(3): 504–509.

18. Řehák Z, Fojtík Z, Szturz P et al. 18F-FDG PET a PET/CT vyšetření v časné diagnostice obrovskobuněčné arteritidy – soubor 39 pacientů. Ces Radiol 2013; 67(1): 62–72.

19. Meller J, Strutz F, Siefker U et al. Early diagnosis and followup of aortitis with [18F]FDG PET and MRI. Eur J Nucl Med Mol Imaging 2003; 30(5): 730–736.

20. Walter MA, Melzer RA, Schindler C et al. 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(6): 674–681.

21. Hauenstein C, Reinhard M, Geiger J et al. Effects of early corticosteroid treatment on magnetic resonance imaging and ultrasonography findings in giant cell arteritis. Rheumatology 2012 51: 1999–2003.

22. Brodmann M, Lipp RW, Passath A et al. 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) 2004; 43(2): 241–242.

23. Belhocine T. The right place of 18FDG PET for the diagnosis of giant cell arteritis – a response to the article of Brodmann et al. Rheumatology (Oxford) 2004; 43(5): 675–676.

24. Belhocine T, Blockmans D, Hustinx R et al. L. Imaging of large vessel vasculitis with 18FDG PET illlusion or reality? A critical revuve of literature data. Eur J Nucl Med Mol Imaging 2003; 30:1305–1315.

25. Gaemperli O, Boyle JJ, Rimoldi OE et al. Molecular Imaging of vascular Inflammation. Eur J Nucl Med Mol Imaging 2010; 37: 1236.

26. Řehák Z, Szturz P, Křen L et al. Upsampling From Aorta and Aortic Branches. PET/CT Hybrid Imaging Identified 18F-FDG Hypermetabolism in Inflamed Temporal and Occipital Arteries. Clin Nucl Med 2013 doi: 10.1097/RLU.0b013e3182868aae

27. Moosig F, Czech N, Mehl C et al. Correlation between 18-fluorodeoxyglucose accumulation in large vessels and serological markers of inflammation in polymyalgia rheumatica: a quantitative PET study. Ann Rheum Dis 2004; 63: 870–873.

28. Blockmans D, De Ceuninck L, Vanderschueren S et al. Repetitive 18F-Fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study in 35 patients. Arthritis Rheum 2006; 55(1): 131–137.

29. Bertagna F, Bosio G, Caobelli F et al. Role of 18F-fluoro­deoxyglucose positron emission tomography/computed tomography for therapy evaluation of patients with large-vessel vasculitis. Jpn J Radiol 2010; 28(3): 199–204.

30. Henes, JC Müller M, Pfannenberg C et al. Cyclophosphamide for large-vessel vasculitis: assessment of response by PET/CT. Clin Exp Rheumatol 2011; 29, supplement 64: S43–S48.

31. Scheel AK, Meller R, Vosshenrich R et al. Diagnosis and follow up of aortitis in the elderly. Ann Rheum Dis 2004; 63: 1507–1510.

32. Hautzel H, Sander O, Heinzel A et al. Assessmentn of large-vessel involvement in giant cell arteritis with 18F-FDG PET: introducing an ROC-analysis-based cutoff ratio. J Nucl Med 2008; 49(7): 1107–1113.

33. Adams H, Raijmakers P, Smulders Y. Polymyalgia Rheumatica and Interspinous FDG Uptake on PET/CT. Clin Nucl Med 2012; 37: 502–505.

Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account