The diagnostic value of FDG PET/CT in Takayasu arteritis
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Department of PET/CT, First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiZhuang Autonomous Region, China Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiZhuang Autonomous Region, China
Received Oct 9, 2020; accepted Oct 9, 2020 doi:10.1007/s12350-020-02412-w
INTRODUCTION Takayasu arteritis (TA) is a rare granulomatous inflammatory disorder that mainly affects large vessels, especially the aorta and its branches. According to a report, its incidence in the United States was 2.6 per million1. Its diagnosis can be extremely challenging due to the non-specificity of the systemic inflammatory manifestations during the early phase of the disease.2 The infiltration of inflammatory cells into the vascular wall occurs in the early course of disease and is also a feature of active TA.3 Functional imaging using FDG PET/CT allows the detection of inflammatory metabolism in vascular walls and has been used for evaluating vascular activity.2,3 CASE SUMMARY A 32-year-old man who had intermittent fever (maximum, 40 °C) for 3 months and failed to respond to antibiotic treatment, had undergone surgical intervention for aortic arch aneurysm and thoracic aortic dissection 4 months prior. The blood test showed that white blood cell was 14.269109 /L, neutrophil was 10.989109 /L, hypersensitive C-reactive protein was 155.26 mgL, and
Reprint requests: Shengcai Huang, MD, Department of PET/CT, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, GuangxiZhuang Autonomous Region, China; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
procalcitonin was 0.03 ngml. Repeated blood cultures were negative, we failed to find evidence of pathogen infection. Contrast-enhanced computed tomography showed only stent fistula in aortic arch aneurysm (Figure 1), but this was not enough to reveal why the patient had recurrent fever. FDG PET/CT imaging not only detected stent fistula, but also inflammation of the thoracic aortic wall and abnormal FDG uptake in the right femoral artery (Figure 2). The diagnosis of TA was confirmed by the American College of Rheumatology, and the patient was treated with intravenous methylprednisolone (50 mg, once daily) and intravenous cyclophosphamide (0.2 g, once daily) for 7 days, with remission of symptoms and inflammation indicators reduced to normal. Over the next six months, the patient received a gradual reduction from 50mg to 4mg of methylprednisolone, a cumulative cyclophosphamide dose of 6.4g, and surgery was performed on the right femoral artery. The patient is now in stable condition. Our case emphasized that PET/CT provided an excellent overview in suspected vasculitis. Particularly in patients with unclear inflammation, PET may detect alternative diagnoses like tumors, lymphoma, or septic foci.
Yang et al The diagnostic value of FDG PET/CT in Takayasu arteritis
Journal of Nuclear CardiologyÒ
Figure 1. Contrast-enhanced CT showed that there were mult
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