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(18)F-FDG PET/CT for the detection of large vessel vasculitis in patients with polymyalgia rheumatica
C Lavado-Pérez1, I Martínez-Rodríguez1, N Martínez-Amador1
1Department of Nuclear Medicine, Molecular Imaging Group (IDIVAL), Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain.
Purpose:
Polymyalgia rheumatica (PMR) may present together with large vessel vasculitis (LVV), and frequently requires a more intensive therapy. The aim of the study was to evaluate the impact of (18)F-FDG PET/CT in the diagnosis and management of LVV associated to PMR.
Material And Methods:
This prospective study included 40 consecutive patients (27 women/13 men, 68.10±10.27 years) with PMR and suspicion of associated LVV submitted for (18)F-FDG PET/CT. A PET/CT scan was obtained 180 min after (18)F-FDG intravenous injection. A visual analysis was performed on the images. Five vascular regions were evaluated: supra-aortic trunks (SAT), thoracic aorta (TA), abdominal aorta (AA), iliac arteries (IA), and femoral/tibioperoneal arteries (FTA). The intensity of uptake was graded from 0 to 3. A final diagnosis of LVV was established in 26/40 patients (65%).
Results:
In the 26 patients with a diagnosis of LVV, the highest intensity of (18)F-FDG uptake was observed in the TA, SAT, and FTA. All of these patients showed uptake at the TA, with grade 2 and 3 in most cases. In 4 of the 14 patients without LVV, no uptake was observed in any vascular region, and in the other 10 patients only a grade 1 uptake was observed in 1 or to 2 territories. Out of the 20 treated LVV patients, (18)F-FDG PET/CT led to a therapeutic change in 17 (85%).
Conclusion:
(18)F-FDG PET/CT was useful in identifying patients with LVV associated to PMR. The detection of vascular inflammation had an important impact, and led to a change of treatment in a high percentage of patients with LVV.
Insights
18F-FDG PET/CT effectively identifies large vessel vasculitis (LVV) in polymyalgia rheumatica (PMR) patients. This imaging technique significantly impacted treatment decisions for a high percentage of diagnosed LVV cases.
Area of Science:
- Nuclear Medicine
- Rheumatology
- Vascular Imaging
Background:
- Polymyalgia rheumatica (PMR) can co-occur with large vessel vasculitis (LVV).
- LVV associated with PMR often necessitates more aggressive treatment strategies.
- Accurate diagnosis of concurrent LVV is crucial for appropriate patient management.
Purpose of the Study:
- To assess the utility of 18F-FDG PET/CT in diagnosing LVV in patients with PMR.
- To evaluate the impact of 18F-FDG PET/CT findings on therapeutic decisions for associated LVV.
Main Methods:
- Prospective study of 40 patients with PMR and suspected LVV.
- 18F-FDG PET/CT scans performed 180 minutes post-injection.
- Visual analysis of five vascular regions (supra-aortic trunks, thoracic aorta, abdominal aorta, iliac arteries, femoral/tibioperoneal arteries) with uptake grading (0-3).
Main Results:
- LVV diagnosed in 26/40 patients (65%).
- Highest 18F-FDG uptake observed in thoracic aorta, supra-aortic trunks, and femoral/tibioperoneal arteries in LVV patients.
- Treatment modification occurred in 85% (17/20) of treated LVV patients based on PET/CT findings.
Conclusions:
- 18F-FDG PET/CT is valuable for detecting LVV in PMR patients.
- Identification of vascular inflammation via PET/CT significantly influenced treatment changes.
- This imaging modality aids in optimizing management for PMR patients with associated LVV.
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