Abstract
Background[F-18]fluorodeoxyglucose positron emission tomography/computed tomography is routinely used for assessing Takayasu arteritis patients. However, extra-vessel [F-18]fluorodeoxyglucose uptake has not been evaluated in detail in these patients. We aimed to describe the extent and distribution of extra-vascular [F-18]fluorodeoxyglucose uptake on positron emission tomography/computed tomography in Takayasu arteritis patients. Seventy-three [F-18]fluorodeoxyglucose positron emission tomography/computed tomography scans from 64 consecutive Takayasu arteritis patients (59 women, mean age, 35.4 years; range, 13 to 71 years) and 40 scans from age-matched controls (36 women, mean age, 37.8 years; range, 13 to 70 years) were examined. We graded [F-18]fluorodeoxyglucose uptake in large vessels using a 4-point scale and evaluated extra-vessel findings. Factors correlated with disease activity were examined. We evaluated the relationship between disease activity according to the National Institutes of Health score with extra-vessel findings, as well as other inflammatory markers (e.g., white blood cell count and C-reactive protein level).ResultsExtra-vessel involvement was present in 50 of 73 (68.4%) scans, specifically at the following sites: lymph nodes, 1.4%; thyroid glands, 17.8%; thymus, 11.0%; spleen, 1.4%; vertebrae, 45.2%; and pelvic bones, 9.6%. Takayasu arteritis patients had higher [F-18]fluorodeoxyglucose uptake in the spine (P = 0.03) and thyroid glands (P = 0.003) than did controls; uptake in other regions was comparable between groups. Compared with inactive patients, those with active Takayasu arteritis had a higher number of [F-18]fluorodeoxyglucose uptake sites in the vasculature (P = 0.001). Finally, patients with a National Institutes of Health score of ≥ 1 had significantly higher extra-vascular involvement (P = 0.008).ConclusionsExtra-vessel [F-18]fluorodeoxyglucose uptake may be present in the context of Takayasu arteritis-related inflammatory processes. Information on extra-vascular [F-18]fluorodeoxyglucose uptake may be useful for detecting and evaluating inflammatory processes when interpreting positron emission tomography/computed tomography scans obtained from Takayasu arteritis patients.
Highlights
Large vessel vasculitis, which includes Takayasu arteritis (TA) and giant cell arteritis, is a rare, chronic inflammatory disease that affects the walls of the aorta and its main branches, as well as the coronary and pulmonary arteries
We evaluated the relationship between disease activity according to National Institutes of Health score with extra-vessel findings, as well as other inflammatory markers (e.g., white blood cell count (WBC) count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR))
Elevated [F-18]FDG accumulation in bone marrow is related to bone marrow activation, as well as the elevation of White blood cell count (WBC) count and CRP level (Inoue et al 2009). [F-18]FDG accumulation in the bone marrow could be due to red marrow hyperplasia caused by bleeding anemia or hematopoietic stimulation treatment (Gordon et al 1997)
Summary
Large vessel vasculitis, which includes Takayasu arteritis (TA) and giant cell arteritis, is a rare, chronic inflammatory disease that affects the walls of the aorta and its main branches, as well as the coronary and pulmonary arteries. The mean age of onset is 35 years, and women are disproportionately affected by this disease (2 to 25-fold higher). TA is potentially life-threatening, with a mortality rate as high as 35%. TA involves non-specific symptoms, such as fever and general weakness. Diagnosis and evaluation of disease activity are difficult. Parameters such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are non-specific and contribute little towards the estimation of disease activity (Hoffman and Ahmed 1998)
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