The utility of PET/CT in large vessel vasculitis

Howard Amital,Jennifer Ben Shimol,Liran Domachevsky,Merav Lidar,Tima Davidson,Yehuda Shoenfeld

doi:10.1038/s41598-020-73818-2

Abstract

18F-FDG PET/CT occupies a growing role in the diagnosis of large vessel vasculitis (LVV), illustrating enhanced uptake in the lining of large vessels. A retrospective single center study was conducted of patients who underwent 18F-FDG PET/CT scans between 2009 and 2019 at Sheba Medical Center, Israel. The imaging results were analyzed for evidence of LVV. We reviewed the PET/CT scans of 126 patients and identified 57 studies that either showed evidence of active LVV or that had been performed in patients previously treated for systemic vasculitis. In 6 patients with fevers of unknown origin and elevated inflammatory markers, PET/CT revealed LVV. Six of 13 patients previously treated for systemic vasculitis demonstrated persistent large vessel uptake. LVV was identified in 8 patients with other autoimmune diseases, and in 4 diagnosed with infectious aortitis. In 26 patients who underwent malignancy surveillance, PET/CT revealed more localized large vessel wall inflammation. Our results illustrate that PET/CT may identify large vessel wall inflammation in patients with a suspicion of LVV, and incidentally in patients who undergo malignancy surveillance. PET/CT may also help delineate the presence and extent of vessel inflammation in patients with LVV and in those with other autoimmune diseases.

Highlights

18F-FDG PET/CT occupies a growing role in the diagnosis of large vessel vasculitis (LVV), illustrating enhanced uptake in the lining of large vessels
Sixty-nine patients were excluded from the analysis because they did not have a history of a systemic vasculitis and there was no evidence of LVV on their 18F-FDG PET/ CT scans
13 had presented with fever of unknown origin (FUO) and had undergone PET/CT scans to evaluate the presence of vasculitis

Summary

Introduction

18F-FDG PET/CT occupies a growing role in the diagnosis of large vessel vasculitis (LVV), illustrating enhanced uptake in the lining of large vessels. Our results illustrate that PET/CT may identify large vessel wall inflammation in patients with a suspicion of LVV, and incidentally in patients who undergo malignancy surveillance. As clinicians increasingly rely on PET/CT in the assessment of GCA, this imaging modality has shown particular value in patients with non-diagnostic temporal biopsies and in patients who are younger and present with atypical symptoms, such as fever of unknown origin (FUO). In this subset, patients more commonly present with vasculitis involving the extratemporal proximal v essels[10].

Objectives

Methods

Results

Discussion

Conclusion