Large vessel vasculitis: imaging standards of 18 F-FDG PET/CT
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INVITED REVIEW
Large vessel vasculitis: imaging standards of 18F‑FDG PET/CT Ukihide Tateishi1 · Junichi Tsuchiya1 · Kota Yokoyama1 Received: 10 September 2020 / Accepted: 13 October 2020 © Japan Radiological Society 2020
Abstract Improvements in positron emission tomography (PET) technology have contributed to increased diagnostic accuracy in patients with large-vessel vasculitis (LVV) over the last decades. Many systematic reviews and meta-analyses were conducted, and earlier diagnosis by 18F-FDG PET can be made in patients suspected of having LVV. Two subtypes, Takayasu arteritis and giant cell arteritis, will progress when poorly responding to corticosteroids and augmented immunosuppression. In most patients, disease activity cannot be monitored by laboratory tests alone; therefore, glucose metabolism may be a source for possible biomarkers. In this review, we present current concepts regarding 18F-FDG PET/CT imaging standards. Keywords Large vessel vasculitis · Takayasu arteritis · Giant cell arteritis · 18F-FDG PET/CT
Introduction Vasculitis is a heterogeneous group of disorders characterized by inflammation and fibrinoid necrosis of blood vessel walls. Large vessel vasculitis (LVV) is a disease predominantly affecting the large arteries and main branches. Pathologic specimens from patients show granulomatous infiltration of various inflammatory cells within the vessel walls of the thoracic and abdominal aorta and their branches. Patients with LVV often present with nonspecific clinical symptoms including fatigue, malaise, weight loss, anorexia, fever, and night sweats. Two subtypes, Takayasu arteritis (TA) and giant cell arteritis (GCA), are known. In most patients, the development of LVV is a progressive process that is an inefficient and impermanent response to treatment. Diagnostic procedures including ultrasound, computed tomography, magnetic resonance imaging, and angiography often give inconclusive results in patients with LVV [1–4]. 18F-FDG PET/CT can detect the activated * Ukihide Tateishi [email protected] Junichi Tsuchiya [email protected] Kota Yokoyama [email protected] 1
Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1‑5‑45, Yushima, Bunkyo‑ku, Tokyo, Japan
inflammatory process within the arterial wall and may be valuable for initial diagnosis, monitoring of disease activity, and evaluating response to treatment in LVV [5, 6]. In this review, we present current concepts regarding the 18F-FDG PET/CT of LVV.
Pathogenesis and cellular mechanism of LVV LVV is regarded as two pathologic conditions: GCA and TA. GCA is the most common reason for idiopathic LVV in patients aged greater than 50 years and affects mainly the thoracic, abdominal aorta, and its primary branches. Its etiology and pathogenesis are still unknown. Classic cranial manifestations consist of headache, scalp tenderness, jaw claudication, and vision loss. Temporal artery biopsy remains the gold standard for diagnosis. Steroid treatment is the standard of care, though not curative. Genes in HLA
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