Gleice Clemente1, Alexandre W de Souza2, Hilton Leão Filho3, Fernando M A Coelho3, Carlos Buchpiguel4, Marcos Lima4, Camila Carneiro4, Rosa M R Pereira5, Nadia Aikawa5, Clovis A Silva6, Lucia M A Campos6, Gabriel Alves7, Camilla Astley5, Bruno Gualano5, Maria Teresa Terreri8. 1. Paediatric Rheumatology Unit, Paediatrics Department, Universidade Federal de Sao Paulo, Doutor Bacelar Street, 173, 12 Floor, Sao Paulo, SP, 04026-000, Brazil. gleiceclemente@gmail.com. 2. Division of Rheumatology, Department of Medicine, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. 3. Radiology Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. 4. Nuclear Medicine LIM-43, Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. 5. Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. 6. Children's Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. 7. Universidade Federal de Sao Paulo, Sao Paulo, Brazil. 8. Paediatric Rheumatology Unit, Paediatrics Department, Universidade Federal de Sao Paulo, Doutor Bacelar Street, 173, 12 Floor, Sao Paulo, SP, 04026-000, Brazil.
Abstract
BACKGROUND: The observation that 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography/magnetic resonance imaging ([18F]F-FDG-PET/MRI) revealed high-grade arterial wall FDG uptake, without arterial wall thickening with contrast-enhancement, in a considerable number of c-TA patients in our previous study, encouraged us to compare patients with both PET and MR angiography (MRA) positives, with those with PET positive but MRA negative. Our aim was to evaluate the relevance of these two imaging modalities together. METHODS: A three-center cross-sectional study with 17 patients who fulfilled the EULAR/PRINTO/PReS criteria for c-TA and who underwent [18F]F-FDG-PET/MRI was previously performed. Herein we compared patients/vessels with positive PET (arterial wall 18F-FDG uptake higher than liver) and positive MRA (arterial wall thickening with contrast-enhancement)-group 1, with those with positive PET but negative MRA-group 2. RESULTS: Median disease duration of 17 c-TA patients was 10.4 years. Nine patients were classified as group 1 and six as group 2. Median of metabolic inflammatory volume (MIV) of all arterial segments was significantly higher in group 1 (2346 vs. 1177 cm3; p = 0.036). Fifty-four (19%) from 284 available arterial segments presented positive findings in vessel wall in one or both images. Positive findings were concordant between PET and MRA in only 13% arterial segments (group 1); most changes (28-59.6%) that were discordant between both images, were positive in PET and negative in MRA (group 2). CONCLUSION: Our study demonstrated that [18F]F-FDG-PET/MRI added information about inflammation in vessel wall of c-TA patients. Prospective multicenter studies are needed in order to get solid data to guide immunosuppressive tapering and withdrawal.
BACKGROUND: The observation that 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography/magnetic resonance imaging ([18F]F-FDG-PET/MRI) revealed high-grade arterial wall FDG uptake, without arterial wall thickening with contrast-enhancement, in a considerable number of c-TA patients in our previous study, encouraged us to compare patients with both PET and MR angiography (MRA) positives, with those with PET positive but MRA negative. Our aim was to evaluate the relevance of these two imaging modalities together. METHODS: A three-center cross-sectional study with 17 patients who fulfilled the EULAR/PRINTO/PReS criteria for c-TA and who underwent [18F]F-FDG-PET/MRI was previously performed. Herein we compared patients/vessels with positive PET (arterial wall 18F-FDG uptake higher than liver) and positive MRA (arterial wall thickening with contrast-enhancement)-group 1, with those with positive PET but negative MRA-group 2. RESULTS: Median disease duration of 17 c-TA patients was 10.4 years. Nine patients were classified as group 1 and six as group 2. Median of metabolic inflammatory volume (MIV) of all arterial segments was significantly higher in group 1 (2346 vs. 1177 cm3; p = 0.036). Fifty-four (19%) from 284 available arterial segments presented positive findings in vessel wall in one or both images. Positive findings were concordant between PET and MRA in only 13% arterial segments (group 1); most changes (28-59.6%) that were discordant between both images, were positive in PET and negative in MRA (group 2). CONCLUSION: Our study demonstrated that [18F]F-FDG-PET/MRI added information about inflammation in vessel wall of c-TA patients. Prospective multicenter studies are needed in order to get solid data to guide immunosuppressive tapering and withdrawal.
Authors: Gleice Clemente; Maria O E Hilario; Henrique Lederman; Clovis A Silva; Adriana M Sallum; Lucia M Campos; Silvana Sacchetti; Maria C dos Santos; Virginia P Ferriani; Flávio Sztajnbok; Rozana Gasparello; Sheila Knupp Oliveira; Marise Lessa; Blanca Bica; André Cavalcanti; Teresa Robazzi; Marcia Bandeira; Maria Teresa Terreri Journal: Clin Exp Rheumatol Date: 2014-01-03 Impact factor: 4.473