Taryn Youngstein1, Enrico Tombetti2, Jaita Mukherjee1, Tara D Barwick3, Adil Al-Nahhas3, Emyr Humphreys4, Julian Nash5, Jacqueline Andrews6, Elena Incerti7, Elisabetta Tombolini8, Annalaura Salerno9, Silvia Sartorelli8, Giuseppe A Ramirez8, Maurizio Papa10, Maria Grazia Sabbadini8, Luigi Gianolli11, Francesco De Cobelli9, Federico Fallanca11, Elena Baldissera12, Angelo A Manfredi8, Maria Picchio11, Justin C Mason13. 1. Cardiovascular Sciences and Rheumatology Units, Imperial College Healthcare National Health Service Trust, London, United Kingdom. 2. Cardiovascular Sciences and Rheumatology Units, Imperial College Healthcare National Health Service Trust, London, United Kingdom; Unit of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3. Imaging Department, Imperial College Healthcare National Health Service Trust, London, United Kingdom; Division of Cancer and Surgery, Imperial College London, London, United Kingdom. 4. Prince Charles Hospital, Merthyr Tydfil, Wales. 5. Rheumatology Unit, University Hospital Wales, Cardiff, Wales. 6. Rheumatology Unit, Chapel Allerton Hospital, Leeds, United Kingdom. 7. Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy; University of Milan, Milan, Italy. 8. Unit of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 9. Vita-Salute San Raffaele University, Milan, Italy; Unit of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 10. Unit of Radiology-Ville Turro, IRCCS San Raffaele Scientific Institute, Milan, Italy. 11. Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy. 12. Unit of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 13. Cardiovascular Sciences and Rheumatology Units, Imperial College Healthcare National Health Service Trust, London, United Kingdom. Electronic address: justin.mason@imperial.ac.uk.
Abstract
OBJECTIVES: This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV). BACKGROUND: The role of 18F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([18F]FDG-PET/CT) in the management of LVV remains to be defined. Although [18F]FDG uptake at arterial graft sites raises concerns regarding active arteritis or infection, its clinical significance in LVV has never been formally studied. METHODS: An observational prospective study sought to identify patients with Takayasu arteritis (TA) undergoing [18F]FDG-PET/CT more than 6 months after graft surgery from a large cohort of patients from 2 tertiary referral centers. [18F]FDG uptake by the graft and native arteries was scored on a scale of 0 to 3 relative to hepatic uptake, and periprosthetic maximum standardized uptake value (SUVmax) was calculated. Periprosthetic [18F]FDG uptake in active disease was compared with that in inactive disease, and arterial progression was assessed by prospective magnetic resonance angiography (MRA). RESULTS: Twenty-six subjects with TA were enrolled. All were afebrile with negative blood culture. Periprosthetic uptake was significant in 23 of 26 patients, and the mean SUVmax was 4.21 ± 1.46. Median periprosthetic [18F]FDG uptake score (3; interquartile range [IQR]: 3 to 3) was higher than in native aorta (1; IQR: 0 to 1; p < 0.001). Graft-specific [18F]FDG uptake was unrelated to disease activity. Despite the high frequency of graft-associated [18F]FDG uptake, sequential MRAs did not reveal arterial progression in 25 of 26 patients; the 1 remaining case showed minor progression limited to native arteries. Nine patients underwent repeated PET/CT scanning without showing changes in graft-specific uptake, despite increased treatment. CONCLUSIONS: Significant [18F]FDG uptake that is confined to arterial graft sites in patients with LVV does not reflect clinically relevant disease activity or progression. To minimize exposure to immunosuppression and in the face of negative blood culture, clinically quiescent arteritis, normal or stably raised C-reactive protein levels, we elected not to escalate treatment and monitor progression with MRA.
OBJECTIVES: This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV). BACKGROUND: The role of 18F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([18F]FDG-PET/CT) in the management of LVV remains to be defined. Although [18F]FDG uptake at arterial graft sites raises concerns regarding active arteritis or infection, its clinical significance in LVV has never been formally studied. METHODS: An observational prospective study sought to identify patients with Takayasu arteritis (TA) undergoing [18F]FDG-PET/CT more than 6 months after graft surgery from a large cohort of patients from 2 tertiary referral centers. [18F]FDG uptake by the graft and native arteries was scored on a scale of 0 to 3 relative to hepatic uptake, and periprosthetic maximum standardized uptake value (SUVmax) was calculated. Periprosthetic [18F]FDG uptake in active disease was compared with that in inactive disease, and arterial progression was assessed by prospective magnetic resonance angiography (MRA). RESULTS: Twenty-six subjects with TA were enrolled. All were afebrile with negative blood culture. Periprosthetic uptake was significant in 23 of 26 patients, and the mean SUVmax was 4.21 ± 1.46. Median periprosthetic [18F]FDG uptake score (3; interquartile range [IQR]: 3 to 3) was higher than in native aorta (1; IQR: 0 to 1; p < 0.001). Graft-specific [18F]FDG uptake was unrelated to disease activity. Despite the high frequency of graft-associated [18F]FDG uptake, sequential MRAs did not reveal arterial progression in 25 of 26 patients; the 1 remaining case showed minor progression limited to native arteries. Nine patients underwent repeated PET/CT scanning without showing changes in graft-specific uptake, despite increased treatment. CONCLUSIONS: Significant [18F]FDG uptake that is confined to arterial graft sites in patients with LVV does not reflect clinically relevant disease activity or progression. To minimize exposure to immunosuppression and in the face of negative blood culture, clinically quiescent arteritis, normal or stably raised C-reactive protein levels, we elected not to escalate treatment and monitor progression with MRA.
Authors: Elena Incerti; Enrico Tombetti; Federico Fallanca; Elena M Baldissera; Pierpaolo Alongi; Elisabetta Tombolini; Silvia Sartorelli; Maria Grazia Sabbadini; Maurizio Papa; Francesco De Cobelli; Justin C Mason; Luigi Gianolli; Angelo A Manfredi; Maria Picchio Journal: Eur J Nucl Med Mol Imaging Date: 2017-02-08 Impact factor: 9.236
Authors: Dan Pugh; Maira Karabayas; Neil Basu; Maria C Cid; Ruchika Goel; Carl S Goodyear; Peter C Grayson; Stephen P McAdoo; Justin C Mason; Catherine Owen; Cornelia M Weyand; Taryn Youngstein; Neeraj Dhaun Journal: Nat Rev Dis Primers Date: 2022-01-06 Impact factor: 65.038
Authors: Andrej Ćorović; Christopher Wall; Justin C Mason; James H F Rudd; Jason M Tarkin Journal: Curr Cardiol Rep Date: 2020-08-09 Impact factor: 3.955