aClinic of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; bClinic of Nuclear Medicine and PET/CT Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; cHealth Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; dDepartment of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
A 80-year-old male patient was admitted to our hospital with fever and increased serum inflammatory markers (erythrocyte sedimentation rate, C-reactive protein and leucocyte count). The patient underwent fluorine-18 fluorodeoxyglucose positron emission tomography / computed tomography angiography (18F-FDG PET/CTA) for suspected large vessel vasculitis (LVV). The patient was instructed to fast for at least 6 h prior to radiopharmaceutical administration.
CTA was normal whereas 18F-FDG PET showed areas of increased glucose metabolism in the cervical region, corresponding to both vertebral arteries on hybrid PET/CTA images (fig. 1). Therefore a diagnosis of LVV limited to the vertebral arteries was hypothesised.
Based on these findings, the patient received corticosteroid therapy with normalisation of symptoms and laboratory data.
18F-FDG PET/CTA is a useful imaging method in the initial diagnosis of LVV and in the assessment of activity and extent of disease [1–3]. This hybrid imaging method may even detect LVV limited to specific arteries. Atherosclerotic vascular uptake may be a source of false positivity in LVV evaluation with 18F-FDG PET, despite a classical patchy uptake pattern; vascular inflammation in LVV classically appears as a smooth linear pattern on 18F-FDG PET . CTA detecting structural changes in large vessels may also be helpful to differentiate LVV and atherosclerosis .
The authors declare no financial support and no potential conflict of interest relevant to this article.
Giorgio Treglia, MD MSc(HTA), Clinic of Nuclear Medicine and PET/CT Centre, Ente Ospedaliero Cantonale, Via Ospedale 12, CH-6500 Bellinzona, giorgio.treglia[at]eoc.ch
1 Treglia G, Mattoli MV, Leccisotti L, Ferraccioli G, Giordano A. Usefulness of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography in patients with large-vessel vasculitis: a systematic review. Clin Rheumatol. 2011;30(10):1265–75. doi:. http://dx.doi.org/10.1007/s10067-011-1828-9 PubMed
2 Slart RHJA; Writing group; Reviewer group; Members of EANM Cardiovascular; Members of EANM Infection & Inflammation; Members of Committees, SNMMI Cardiovascular; Members of Council, PET Interest Group; Members of ASNC; EANM Committee Coordinator. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging. 2018;45(7):1250–69. doi:. http://dx.doi.org/10.1007/s00259-018-3973-8 PubMed
3 Mattoli MV, Treglia G, Leccisotti L, Giordano A. The role of 18F-FDG PET/CT in the management of large-vessel vasculitis: applications and limitations in clinical practice. Ital J Med. 2011;5(3):249–54. doi:. http://dx.doi.org/10.1016/j.itjm.2011.03.012
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