Does 18F-FDG-PET/MRI Add Metabolic Information to Anatomic Image in Childhood-onset Takayasu’s Arteritis Patients? A Multicenter Case Series

Gleice Clemente¹, Alexandre Souza², Hilton Leão Filho³, Fernando Coelho³, Carlos Buchpiguel⁴, Marcos Lima⁴, Daniela Petry Pioto⁵, Melissa Fraga¹, Ana Paula Sakamoto⁶, Camila Carneiro⁴, Rosa Pereira⁷, Nadia Aikawa⁷, Clovis Artur Silva⁷, Lucia Campos⁸, Camilla Astley⁹, Bruno Gualano¹⁰ and Maria Terreri¹¹, ¹Universidade Federal de São Paulo, São Paulo, Brazil, ²UNIFESP-EPM, São Paulo, Brazil, ³Universidade de Sao Paulo/Radiology Institute, São Paulo, Brazil, ⁴Universidade de São Paulo/Department of Radiology and Oncology, São Paulo, Brazil, ⁵Pediatric Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil, ⁶Federal University of So Paulo (UNIFESP), São Paulo, Brazil, ⁷Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ⁸children's institute, Sao Paulo, Brazil, ⁹University of Sao Paulo, Sao Paulo, Brazil, ¹⁰Universidade de Sao Paulo/Rheumatology Division, São Paulo, Brazil, ¹¹UNIFESP, São Paulo, Brazil

Meeting: ACR Convergence 2021

Keywords: Imaging, kid, Magnetic resonance imaging (MRI), Takayasu.s arteritis, Vasculitis

Session Information

Date: Saturday, November 6, 2021

Session Title: Imaging of Rheumatic Diseases Poster (0149–0182)

Session Type: Poster Session A

Session Time: 8:30AM-10:30AM

Background/Purpose: The disease activity assessment in c-TA is a challenge in clinical practice, especially in patients who are under immunosuppression. Our aim was to perform comparison between positron emission tomography (PET) and magnetic resonance angiography (MRA) findings in childhood-onset Takayasu’s arteritis (c-TA) patients.

Methods: A three-center cross-sectional study with 17 children and adolescents who fulfilled the EULAR/PRINTO/PReS criteria for c-TA was conducted. The patients underwent ¹⁸F-FDG-PET/MRI imaging (SIGMA^TM PET/MR, GE Healthcare, Milwakee-MI, USA). Positive MRA consisted of arterial wall thickening with contrast-enhancement, whereas positive PET was defined as arterial wall uptake higher than the normal liver degree of FDG uptake. Patients were divided in three groups according to the different combinations of imaging findings as following: group 1 (PET+MRA+), group 2 (PET+MRA-) and group 3 (PET-MRA+).

Results: Seventeen c-TA patients (65% female) were included. Mean disease duration was nine ±3.6 years. PET identified high-grade ¹⁸F-FDG arterial wall uptake in 15 (88.2%) patients and MRA detected thickening with contrast-enhancement in 10 (58.8%). Nine patients were classified as group 1, six as group 2 and 1 as group 3. One patient had no vessel-wall changes in both images. Median of metabolic inflammatory volume (MIV) value was significantly higher in group 1 compared to group 2 (2346 vs. 1177 cm³; p=0.036) (Table 1). Fifty-four (19%) from 284 available arterial segments presented vessel-wall changes in one or both imaging. Positive PET was found in 35 (12.3%) and positive MRA in 26 (9.2%) vessels (Table 2). Positive findings in vessel-wall were concordant between PET and MRA exams in seven (2.5%) and were not concordant in 47 (16.5%) arterial segments.

Conclusion: Our study demonstrated that ¹⁸F-FDG-PET/MRI is a new exam that adds metabolic information to anatomic image in c-TA patients, and may help therapeutic decision, especially for those during immunosuppressive withdrawal.

Table 1 – Clinical, laboratorial, treatment data and PET findings in group 1 and 2 in c-TA patients.
c-TA: childhood-onset Takayasu’s arteritis; ESR: erythrocyte sedimentation rate; CRP: C reactive protein; PET: positron emission tomography; MRA: magnetic resonance angiography; SUVmax: maximum standardized uptake value; MIV: metabolic inflammatory volume. Numerical values are presented in median (IQR). *1 patient had no vessel wall changes in MRA or PET imaging and 1 patient had vessel-wall changes in MRA but no vessel-wall changes in PET.

Table 2 – PET and MRA findings according to each arterial segment (N=284) in c-TA patients
c-TA: childhood-onset Takayasu’s arteritis; PET: positron emission tomography; MRA: magnetic resonance angiography; VS: visual score; T+E: thickening + enhancement; RCC: right common carotid; LCC: left common carotid * Vessel-wall changes in PET and MRA that have undergone surgical intervention (5 arterial segments) were not considered.

Disclosures: G. Clemente, None; A. Souza, None; H. Leão Filho, None; F. Coelho, None; C. Buchpiguel, None; M. Lima, None; D. Pioto, None; M. Fraga, None; A. Sakamoto, None; C. Carneiro, None; R. Pereira, None; N. Aikawa, None; C. Silva, None; L. Campos, None; C. Astley, None; B. Gualano, None; M. Terreri, Sanofi, 6, Alexion, 6, Pfizer, 6, Novartis, 6, Abbvie, 6, Roche, 6, Biomarin, 6, GSK, 6, Jansen, 12, Clinical studies, UCB, 12, Clinical studies, Bristol, 12, Clinical studies, Lilly, 12, Clinical studies.

To cite this abstract in AMA style:

Clemente G, Souza A, Leão Filho H, Coelho F, Buchpiguel C, Lima M, Pioto D, Fraga M, Sakamoto A, Carneiro C, Pereira R, Aikawa N, Silva C, Campos L, Astley C, Gualano B, Terreri M. Does 18F-FDG-PET/MRI Add Metabolic Information to Anatomic Image in Childhood-onset Takayasu’s Arteritis Patients? A Multicenter Case Series [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 10). https://acrabstracts.org/abstract/does-18f-fdg-pet-mri-add-metabolic-information-to-anatomic-image-in-childhood-onset-takayasus-arteritis-patients-a-multicenter-case-series/. Accessed December 6, 2021.

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