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Abstract Number: 062

Is Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) a Reliable Tool for Detecting Vascular Activity in Treated Childhood-Onset Takayasu’s Arteritis (C-TA)? A Multicenter Study

Gleice Russo1, Rosa Pereira 2, Nadia Aikawa 3, Clovis Silva 4, Lucia Campos 5, Ana Paula Sakamoto 6, Alexandre Souza 7 and Maria Teresa Terreri 4, 1Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil, 2University of São Paulo, Sao Paulo, Brazil, 3University of Sao Paulo, Sao Paulo, Brazil, 4Sao Paulo, Brazil, 5children's institute, Sao Paulo, Brazil, 6São Paulo, Brazil, 7UNIFESP-EPM, São Paulo, Brazil

Meeting: 2020 Pediatric Rheumatology Symposium

Keywords: children, Magnetic resonance imaging (MRI), positron emission tomography (PET), Takayasu arteritis

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Session Information

The 2020 Pediatric Rheumatology Symposium, originally scheduled for April 29 – May 2, was postponed due to COVID-19; therefore, abstracts were not presented as scheduled.

Date: Thursday, April 30, 2020

Session Title: Poster Session 1

Session Type: ACR Abstract Session

Session Time: 6:00PM-7:00PM

Background/Purpose: The improving therapeutic approach towards childhood-onset Takayasu’s arteritis (c-TA) has decreased the mortality rate over the years and increased concerns on how to improve disease monitoring on an ongoing basis. Our aim was to assess whether 18F-FDG-PET/MRI can contribute in detecting vessel wall inflammation by increased 18F-FDG uptake in patients under immunosuppressive therapy and in apparent remission of the disease.

Methods: It was a three-center cross-sectional study where we analysed a combined imaging of 18F-FDG-PET and MRA in an integrated system. 18F-FDG-PET/MRI scan was performed in c-TA patients, alongside clinical evaluation through clinical activity score (Indian Takayasu Arteritis Clinical Activity Score – ITAS2010 and Pediatric Vasculitis Activity Score – PVAS), and damage score (Takayasu Arteritis Damage Score – TADS and Pediatric Vasculitis Damage Index – PVDI) and laboratorial analysis providing measures of ESR, CRP, HMGB1 (High Mobility Group Box 1), IFN-γ, IL-10, IL-12p70, IL -1ra, IL-1β, IL-6, TNF-α, VEGF and PDGF. There were control groups for the serum and plasma cytokine levels (healthy controls) and for arterial 18F-FDG-PET/MRI (oncologic patients) findings.

Results: Seventeen c-TA patients (65% females) between the ages of 6 and 21 years, with median disease duration of 9.4 years were recruited. Only 1 patient presented clinical disease activity according to the ITAS2010 and 6 of them (35.6%) had increased ESR and/or CRP. The most frequent MRA finding was stenosis, followed by thickness, visualized in 82.4% and 75%, respectively. 18F-FDG-PET revealed that 88.2% patients had FDG uptake higher than liver (visual score=3) in at least 1 arterial segment. The qualitative assessment of vascular FDG uptake across the arterial segments – PETVAS – was 21.8 ± 3.3. Median SUVmax was 3.22 (2.76-3.69) and mean metabolic inflammatory volume (MIV) was 1990cm3 ± 1077. Patients presented significantly higher SUVmax than controls (p< 0.001). Plasma IFN-γ levels showed a tendency to be higher in patients compared to controls (p=0.052). There was a negative moderate correlation between aortic wall thickness extent and IL-1ra (Rho= -0.662; p= 0.037). Finally, there was a positive moderate correlation between SUVmax and CRP levels (Rho=0.528; p= 0.029) and also with MIV value (Rho=0.615; p=0.009).

Conclusion: This study applied a state-of-the-art imaging modality that revealed a strong vascular FDG uptake regardless of the clinical and laboratorial assessments. We suppose that this finding may mean a silent activity in the vessel wall. However, only a prospective international multicentre initiative could clarify whether these changes will lead to further arterial lesion progression and would help to guide the therapy more adequately for c-TA.


Disclosure: G. Russo, None; R. Pereira, None; N. Aikawa, None; C. Silva, None; L. Campos, None; A. Sakamoto, None; A. Souza, None; M. Terreri, None.

To cite this abstract in AMA style:

Russo G, Pereira R, Aikawa N, Silva C, Campos L, Sakamoto A, Souza A, Terreri M. Is Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) a Reliable Tool for Detecting Vascular Activity in Treated Childhood-Onset Takayasu’s Arteritis (C-TA)? A Multicenter Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 4). https://acrabstracts.org/abstract/is-positron-emission-tomography-magnetic-resonance-imaging-pet-mri-a-reliable-tool-for-detecting-vascular-activity-in-treated-childhood-onset-takayasus-arteritis-c-ta-a-multicenter-study/. Accessed January 27, 2023.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-positron-emission-tomography-magnetic-resonance-imaging-pet-mri-a-reliable-tool-for-detecting-vascular-activity-in-treated-childhood-onset-takayasus-arteritis-c-ta-a-multicenter-study/

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