Session Title: Vasculitis
Session Type: Abstract Submissions (ACR)
18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is considered as a useful tool in assessing active vascular inflammation in large vessel vasculitis. Lower extremity vein thrombosis is the most common type of vascular disease in BS followed by vena cava thrombosis, pulmonary artery involvement and peripheral arterial aneurysms. Pulmonary artery involvement is mainly manifested by pulmonary artery aneurysms and solely by ‘in situ’ pulmonary artery thrombosis. Varying and multiple pulmonary parenchymal lesions such as nodules, consolidations and cavities make part of this involvement as well (1). Apart from a few case reports, information on the diagnostic value of PET/CT in vascular disease of BS is limited (2-3). We investigated the potential of PET/CT to evaluate the extent and activity of disease in vascular disease due to BS.
Thirty-three (30 M/3 F) patients with BS between March 2012 and April 2014 were studied. The mean age and the mean disease duration were 32±7 and 4±3 years, respectively. All patients had one or more type of large vessel disease such as: deep vein thrombosis of lower extremities (n=31), pulmonary artery involvement (n=14), vena cava superior (n=1) or inferior thrombosis (n =9) and Budd-Chiari syndrome (n=5). FDG PET/CT studies were performed within the first 2 weeks of diagnosis in 23 patients. In the remaining 10, scans were obtained for activity assessment during the follow-up. Maximum standardized uptake values (max SUVs) and visual analyses were used to interpret the FDG PET/CT images. In addition, non-enhanced CT findings obtained during FDG PET/CT were recorded.
FDG PET/CT was positive (SUV ≥ 2; equal to or greater than liver uptake) in 15 (45 %) patients. These included 11 patients with pulmonary artery involvement (11/14, 79 %). Among these 11 patients, FDG uptake was observed in the lung parenchyma (in the form of nodules, consolidations or cavities) in 8, in the hilar region suggesting lymphadenopathy in 6 patients and in 1 patient, suggesting thrombus of a pulmonary artery aneurysm. Among the 19 patients with major venous vessel involvement, FDG uptake was observed in 4 patients (4/19, 21 %) and these was in the femoro-popliteal vessels.
This preliminary survey showed that in BS, FDG uptake was mainly observed at the pulmonary parenchyma while pulmonary arteries did not show increased uptake. Disease in peripheral major veins, on the other hand, can only occasionally be discerned by FDG PET/CT. Further studies might still be needed among immunosuppressive naïve patients.
1) Seyahi E, et al. Pulmonary artery involvement and associated lung disease in Behçet disease: a series of 47 patients. Medicine (Baltimore). 2012;91:35-48.
2) Trad S et al. 18F-fluorodeoxyglucose-positron emission tomography scanning is a useful tool for therapy evaluation of arterial aneurysm in Behçet’s disease. Joint Bone Spine. 2013;80:420-3.
3) Denecke T et al. PET/CT visualises inflammatory activity of pulmonary artery aneurysms in Behçet disease. Eur J Nucl Med Mol Imaging. 2007;34:970.
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