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Takasaki A, Kurita T, Hirota Y, Uno K, Kirii Y, Ichikawa M, Ishiyama M, Terashima M, Nakajima A, Dohi K. Isolated Coronary Arteritis Treated With FDG-PET/CT-Guided Immunosuppressant to Break the Vicious Cycle of In-Stent Restenosis. JACC Case Rep 2023; 28:102102. [PMID: 38204559 PMCID: PMC10774826 DOI: 10.1016/j.jaccas.2023.102102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 01/12/2024]
Abstract
Recurrent in-stent restenosis of the coronary artery is a rare but intractable problem. In this situation, coronary arteritis should be considered as an etiology. This case highlights the use of immunosuppressive drugs, including tocilizumab, and follow-up F-18-fluorodeoxyglucose positron emission tomography/computed tomography to break the vicious circle of recurrent stenosis caused by isolated coronary arteritis of unknown cause.
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Affiliation(s)
- Akihiro Takasaki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yumi Hirota
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kenta Uno
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yosuke Kirii
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Mizuki Ichikawa
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masaki Ishiyama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | | | - Ayako Nakajima
- Center for Rheumatic Diseases, Mie University Hospital, Tsu, Mie, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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2
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Liu L, Li J, Gan T, Yang Y, Tian X. Isolated Coronary Arteritis in Adults: a Single-Center Experience from China. J Cardiovasc Transl Res 2023; 16:1184-1193. [PMID: 37097590 DOI: 10.1007/s12265-023-10388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
Isolated coronary arteritis (ICA) is an extremely rare and life-threatening vasculitis with only a limited number of reports in the literature. We retrospectively reviewed the clinical data of 10 ICA patients in our center from 2012 to 2022 and compared them with patients with Takayasu arteritis who presented with coronary arteritis initially (TAK-CA patients). We found that ICA predominantly affected women and most commonly involved the ostium and the proximal segment of the coronary arteries, causing mainly stenotic lesions. The C-reactive protein and erythrocyte sedimentation rate were grossly normal and significantly lower than those of TAK-CA patients (p = 0.027, p = 0.009, respectively). Intravascular ultrasound imaging showed superiority in differentiating coronary vasculitis from atherosclerosis. Restenosis of the coronary arteries occurred rapidly if not treated promptly and appropriately. Systemic glucocorticoid combined with immunosuppressive agents, especially cyclophosphamide, was a promising strategy for treating ICA.
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Affiliation(s)
- Lingyu Liu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Jing Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Tianpeng Gan
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yunjiao Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, 100730, China.
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Bacour YAA, van Kanten MP, Smit F, Comans EFI, Akarriou M, de Vet HCW, Voskuyl AE, van der Laken CJ, Smulders YM. Development of a simple standardized scoring system for assessing large vessel vasculitis by 18F-FDG PET-CT and differentiation from atherosclerosis. Eur J Nucl Med Mol Imaging 2023; 50:2647-2655. [PMID: 37115211 PMCID: PMC10317865 DOI: 10.1007/s00259-023-06220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/02/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE This study is to develop a structured approach to distinguishing large-artery vasculitis from atherosclerosis using 18-fluorodeoxyglucose positron emission tomography combined with low-dose computed tomography (FDG PET/CT). METHODS FDG PET/CT images of 60 patients were evaluated, 30 having biopsy-proven giant cell arteritis (GCA; the most common form of large-artery vasculitis), and 30 with severe atherosclerosis. Images were evaluated by 12 nuclear medicine physicians using 5 criteria: FDG uptake pattern (intensity, distribution, circularity), the degree of calcification, and co-localization of calcifications with FDG-uptake. Criteria that passed agreement, and reliability tests were subsequently analysed for accuracy using receiver operator curve (ROC) analyses. Criteria that showed discriminative ability were then combined in a multi-component scoring system. Both initial and final 'gestalt' conclusion were also reported by observers before and after detailed examination of the images. RESULTS Agreement and reliability analyses disqualified 3 of the 5 criteria, leaving only FDG uptake intensity compared to liver uptake and arterial wall calcification for potential use in a scoring system. ROC analysis showed an area under the curve (AUC) of 0.90 (95%CI 0.87-0.92) for FDG uptake intensity. Degree of calcification showed poor discriminative ability on its own (AUC of 0.62; 95%CI 0.58-0.66). When combining presence of calcification with FDG uptake intensity into a 6-tiered scoring system, the AUC remained similar at 0.91 (95%CI 0.88-0.93). After exclusion of cases with arterial prostheses, the AUC increased to 0.93 (95%CI 0.91-0.95). The accuracy of the 'gestalt' conclusion was initially 89% (95%CI 86-91%) and increased to 93% (95%CI 91-95%) after detailed image examination. CONCLUSION Standardised assessment of arterial wall FDG uptake intensity, preferably combined with assessment of arterial calcifications into a scoring method, enables accurate, but not perfect, distinction between large artery vasculitis and atherosclerosis.
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Affiliation(s)
- Y A A Bacour
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - M P van Kanten
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - F Smit
- Department of Radiology and Nuclear Medicine, Alrijne Hospital, Simon, Smitweg 1, 2353GA, Leiderdorp, The Netherlands
| | - E F I Comans
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, PO Box 7057, Amsterdam 1007MB, Amsterdam, The Netherlands
| | - M Akarriou
- Department of Radiology and Nuclear Medicine, Spaarne Hospital, PO Box 770, Hoofddorp, 2130AT, The Netherlands
| | - H C W de Vet
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VrijeUniversiteit Amsterdam, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - A E Voskuyl
- Amsterdam UMC-Location VUmc, Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - C J van der Laken
- Amsterdam UMC-Location VUmc, Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - Y M Smulders
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands.
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Poznyak AV, Sukhorukov VN, Eremin II, Nadelyaeva II, Orekhov AN. Diagnostics of atherosclerosis: Overview of the existing methods. Front Cardiovasc Med 2023; 10:1134097. [PMID: 37229223 PMCID: PMC10203409 DOI: 10.3389/fcvm.2023.1134097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
Atherosclerosis was and remains an extremely common and serious health problem. Since the elderly are most at risk of cardiovascular risk, and the average life expectancy is increasing, the spread of atherosclerosis and its consequences increases as well. One of the features of atherosclerosis is its asymptomaticity. This factor makes it difficult to make a timely diagnosis. This entails the lack of timely treatment and even prevention. To date, in the arsenal of physicians, there is only a limited set of methods to suspect and fully diagnose atherosclerosis. In this review, we have tried to briefly describe the most common and effective methods for diagnosing atherosclerosis.
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Liu L, Li J, Yang Y, Hu C, Tian X. Altered glycosylation profiles of serum IgG in Takayasu arteritis. Eur J Med Res 2023; 28:69. [PMID: 36755310 PMCID: PMC9906894 DOI: 10.1186/s40001-023-01035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Takayasu arteritis (TAK) is an autoimmune inflammatory disorder with an undefined etiology. This study aimed to characterize the glycosylation profiles of serum immunoglobulin G (IgG) in patients with TAK. METHODS Lectin microarrays containing 56 types of lectins were used to detect the glycan levels of serum IgG in 164 patients with TAK, 128 patients with atherosclerosis used as disease controls (DCs), and 100 healthy controls (HCs). Differentially altered glycosylation patterns between TAK and control groups as well as between TAK subgroups were identified and further validated by lectin blot. The classification performance of the TAK-specific glycosylation change was measured by receiver-operating characteristic (ROC) curve analysis. RESULTS Lectin microarray analysis revealed significantly increased N-Acetylgalactosamine (GalNAc) levels in the TAK group compared to the DC and HC groups (all p < 0.01). For TAK subgroups, significantly decreased mannosylation was observed in patients with active TAK compared to patients with inactive disease (p < 0.01). These differences were validated by lectin blot. In addition, GalNAc levels exhibited a considerable potential for discriminating patients with TAK from patients with atherosclerosis, with an area under the curve of 0.749 (p < 0.001), a sensitivity of 71.7%, and a specificity of 73.8%. CONCLUSIONS Serum IgG in patients with TAK displayed disease-specific glycosylation alterations. Aberrant GalNAc glycosylation showed substantial value as a diagnostic biomarker. The potential proinflammatory properties of the abnormal glycans may provide new insights into the role of humoral immunity in the pathogenesis of TAK.
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Affiliation(s)
- Lingyu Liu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jing Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yunjiao Yang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Chaojun Hu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
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6
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Kadian-Dodov D, Seo P, Robson PM, Fayad ZA, Olin JW. Inflammatory Diseases of the Aorta: JACC Focus Seminar, Part 2. J Am Coll Cardiol 2022; 80:832-844. [PMID: 35981827 DOI: 10.1016/j.jacc.2022.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 10/15/2022]
Abstract
Inflammatory aortitis is most often caused by large vessel vasculitis (LVV), including giant cell arteritis, Takayasu's arteritis, immunoglobulin G4-related aortitis, and isolated aortitis. There are distinct differences in the clinical presentation, imaging findings, and natural history of LVV that are important for the cardiovascular provider to know. If possible, histopathologic specimens should be obtained to aide in accurate diagnosis and management of LVV. In most cases, corticosteroids are utilized in the acute phase, with the addition of steroid-sparing agents to achieve disease remission while sparing corticosteroid toxic effects. Endovascular and surgical procedures have been described with success but should be delayed until disease control is achieved whenever possible. Long-term management should include regular follow-up with rheumatology and surveillance imaging for sequelae of LVV.
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Affiliation(s)
- Daniella Kadian-Dodov
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Philip M Robson
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zahi A Fayad
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey W Olin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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7
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Kramarič J, Ješe R, Tomšič M, Rotar Ž, Hočevar A. COVID-19 among patients with giant cell arteritis: a single-centre observational study from Slovenia. Clin Rheumatol 2022; 41:2449-2456. [PMID: 35366735 PMCID: PMC8976457 DOI: 10.1007/s10067-022-06157-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Patients with giant cell arteritis (GCA) represent a fragile population with an increased infection risk. In a recent study, older age, a higher number of comorbidities, higher disease activity and prednisolone ≥ 10 mg/day were associated with worse COVID-19 outcome. We aimed to evaluate the frequency and severity of COVID-19 in a well-defined GCA cohort. METHODS We reviewed medical records of histologically and/or by imaging-proven GCA patients diagnosed between September 2011 and February 2020 at our secondary/tertiary centre and followed during the COVID-19 pandemic between March 2020 and February 2022 (24 months). Descriptive statistics were used to explore the studied population. RESULTS Of 314 patients with GCA diagnosed for the first time during a 102-month period, 49 patients died before March 2020. Of the remaining 265 patients, 55 (20.8%) patients suffered from a total of 57 SARS-CoV-2 infections. We observed 44 (77.2%) mild and 13 (22.8%) severe COVID-19 episodes (the latter defined as needing hospitalization, death or thrombotic complication). Patients with severe COVID-19 were more likely to have arterial hypertension (12 [92.3%] vs. 25 [56.8%]; p = 0.022), cardiovascular disease (7 [53.8%] vs. 10 [22.7%]; p = 0.043) or obesity (5 [38.5%] vs. 5 [11.4%]; p = 0.038). Neither prednisolone dose 1-5 mg/day (p = 0.483) nor leflunomide use (p = 1.000) was associated with COVID-19 course. There were no significant differences in sex, age, GCA type, GCA disease duration and other comorbidities in patients with mild and severe COVID-19 in our cohort. CONCLUSION More than a fifth of our GCA patients had severe COVID-19. Treatment with leflunomide or low doses of glucocorticoids were not associated with severe course in our cohort. Key Points • Treatment with leflunomide or low doses of glucocorticoids were not associated with worse COVID-19 outcome. • Outcomes of COVID-19 improved as the COVID-19 pandemic, prevention and treatment options evolved. • Arterial hypertension, cardiovascular disease or obesity were associated with severe COVID-19.
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Affiliation(s)
- Jelka Kramarič
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000, Ljubljana, Slovenia.
| | - Rok Ješe
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000, Ljubljana, Slovenia
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Žiga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Alojzija Hočevar
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova 62, 1000, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Guo Y, Du J, Li T, Gao N, Pan L. Clinical features and risk factors of intracranial artery disease in patients with Takayasu arteritis. Clin Rheumatol 2022; 41:2475-2481. [PMID: 35438374 DOI: 10.1007/s10067-022-06168-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES It has been known that aorta, subclavian, and extracranial arteries are commonly involved in Takayasu arteritis (TA). However, the involvement of intracranial artery in TA has not been well explored. The purpose of this study was to describe the clinical characteristics of intracranial artery lesions in TA patients and identify associated risk factors. METHODS A total of 160 patients diagnosed with TA at Beijing Anzhen Hospital from November 2012 to November 2019 were retrospectively enrolled in this study and assigned to different groups according to the presence or absence of intracranial artery lesions. RESULTS Our data showed that 20% of the enrolled 160 patients developed intracranial artery lesions and the right internal carotid artery (ICA) was the most common involved artery (53%). The average age of patients with intracranial artery lesions was significantly older compared to that of patients without intracranial artery involvement (43.56 ± 11.40 vs 36.41 ± 12.22, p = 0.003). In addition, more patients in the intracranial artery group had concomitant disease histories of stroke and/or hypertension (p = 0.010, 0.033). Chest tightness, chest pain, palpitation, coronary artery lesions, and extracranial segment lesions of ICA were more commonly observed in patients with intracranial artery lesions (p < 0.001, 0.017, 0.015, < 0.001, 0.003). Furthermore, we discovered that patients with coronary artery involvement, extracranial segment lesions of ICA, and higher Vasculitis Damage Index (VDI) score had an increased risk of developing intracranial artery lesions (p = 0.013, 0.019, 0.019). CONCLUSION Our study showed that the intracranial artery disease was common in TA and was associated with coronary artery lesions, extracranial segment lesions of ICA, and higher VDI score. Key Points • Intracranial artery disease in TA patients had advanced age and higher triglyceride level. • Besides coronary artery lesions, intracranial artery disease in TA patients was associated with the extracranial segment lesions of ICA and higher VDI score.
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Affiliation(s)
- Yanqiu Guo
- Department of Rheumatology, Beijing Anzhen Hospital Affiliated to Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Juan Du
- Department of Rheumatology, Beijing Anzhen Hospital Affiliated to Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Taotao Li
- Department of Rheumatology, Beijing Anzhen Hospital Affiliated to Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Na Gao
- Department of Rheumatology, Beijing Anzhen Hospital Affiliated to Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Lili Pan
- Department of Rheumatology, Beijing Anzhen Hospital Affiliated to Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China.
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Oerding C, Uhlmann F, Wollmann J, Kaden I, Wohlfarth K. Carotid Artery Stenosis and Ischemic Strokes in Patients with Giant Cell Arteritis: A Characteristic Pattern-Literature Review and Case Report. TH OPEN : COMPANION JOURNAL TO THROMBOSIS AND HAEMOSTASIS 2022; 6:e40-e49. [PMID: 35112048 PMCID: PMC8801894 DOI: 10.1055/a-1704-0741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
Purpose Ischemic stroke is a relatively rare complication of giant cell arteritis often accompanied by vessel stenosis. Our purpose was to compare the location of internal carotid artery stenosis in GCA patients by performing a literature review suggesting a specific and characteristic pattern. Methods We performed a PubMed research including all articles and cited articles reporting cases and case series about giant cell arteritis patients with internal carotid artery stenosis and ischemic strokes. Results In this case series 39 cases were included. We found a clear tendency of giant cell arteritis-related stenosis to be in the intracranial segments (35/39 (89.7%)). Only in 8/39 (20.5%) patients there was further involvement of extracranial segments. Many cases (27/39 [69.2%]) showed a bilateral involvement. Discussion This literature review reveals a specific pattern of internal carotid artery involvement in patients with giant cell arteritis and ischemic strokes. To our knowledge this pattern has not been reported as a sign strongly pointing toward giant cell arteritis before. We have not found case reports mentioning other common types of vasculitis reporting this involvement pattern. Conclusion Internal carotid artery stenosis and ischemic stroke is a rare complication in patients with giant cell arteritis. Considering the characteristic features of bilateral distal internal carotid artery stenosis giant cell arteritis should be suspected which potentially leads to an early diagnosis and immunotherapy.
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Affiliation(s)
- Clemens Oerding
- Department of Neurology, BG-Hospital Bergmannstrost, Halle (Saale), Germany,Address for correspondence Clemens Oerding, MD Department of Neurology, BG-Hospital BergmannstrostMerseburger Str. 165, 06112 Halle (Saale)Germany
| | - Frank Uhlmann
- Department of Neurology, BG-Hospital Bergmannstrost, Halle (Saale), Germany
| | - Johannes Wollmann
- Department of Neurology, BG-Hospital Bergmannstrost, Halle (Saale), Germany
| | - Ingmar Kaden
- Department of Radiology, BG-Hospital Bergmannstrost, Halle (Saale), Germany
| | - Kai Wohlfarth
- Department of Neurology, BG-Hospital Bergmannstrost, Halle (Saale), Germany
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Nardi-Agmon I, Hamdan A, Eisen A, Orvin K, Porter A, Vaknin-Assa H, Itchaki G, Molad Y, Kornowski R, Itzhaki Ben Zadok O. Diffused coronary involvement in Takayasu arteritis with concomitant malignancy. Clin Rheumatol 2021; 41:921-928. [PMID: 34839417 DOI: 10.1007/s10067-021-06000-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 01/17/2023]
Abstract
Large vessel vasculitis (LVV) is composed of conditions in which inflammation of blood vessel walls affects mainly large arteries, such as the aorta and its main branches, and in some cases the coronary arteries. Coronary artery involvement in systemic vasculitis is associated with significant morbidity and mortality. We present a case of a young patient diagnosed with extensive coronary disease diagnosed as Takayasu arteritis, when whom a concomitant diagnosis of Hodgkin's lymphoma was made. The literature review revealed ten cases of malignancies associated with Takayasu arteritis. We discuss the complexity of the management of concurrent hematological malignancy with TAK and extensive coronary arteritis. This complicated and cross-disciplinary case also represents the pivotal importance of multi-disciplinary team decision in order to achieve the best clinical outcome of both disorders.
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Affiliation(s)
- Inbar Nardi-Agmon
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Ashraf Hamdan
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Eisen
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Katia Orvin
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avital Porter
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hana Vaknin-Assa
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Itchaki
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Hematology Division, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel
| | - Yair Molad
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Rheumatology Division, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Osnat Itzhaki Ben Zadok
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Kwon OC, Jeon TJ, Park MC. Vascular Uptake on 18F-FDG PET/CT During the Clinically Inactive State of Takayasu Arteritis Is Associated with a Higher Risk of Relapse. Yonsei Med J 2021; 62:814-821. [PMID: 34427067 PMCID: PMC8382731 DOI: 10.3349/ymj.2021.62.9.814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate whether vascular uptake on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) during the clinically inactive state of Takayasu arteritis (TAK) is associated with disease relapse. MATERIALS AND METHODS Patients with TAK who underwent 18F-FDG PET/CT during the clinically inactive state of the disease between 2006 and 2019 were included. Clinically inactive disease was defined as a status not fulfilling the National Institutes of Health (NIH) criteria for active disease in TAK. Relapse was defined as recurrence of clinically active disease after a clinically inactive period, requiring change in the treatment regimen. Vascular uptake on 18F-FDG PET/CT was assessed using target/background ratio (TBR), calculated as arterial maximum standardized uptake value (SUV)/mean SUV in venous blood pool. Multivariable Cox regression analysis was performed to identify factors associated with relapse. RESULTS A total of 33 patients with clinically inactive TAK were included. During a median observation period of 4.5 (0.9-8.1) years, relapse occurred in 9 (27.3%) patients at median 1.3 (0.7-6.9) years. Notably, TBR [1.5 (1.3-1.8) vs. 1.3 (1.1-1.4), p=0.044] was significantly higher in patients who relapsed than in those who did not. On multivariable Cox regression analysis, the presence of NIH criterion 2 [adjusted hazard ratio (HR): 7.044 (1.424-34.855), p=0.017] and TBR [adjusted HR: 11.533 (1.053-126.282), p=0.045] were significantly associated with an increased risk of relapse. CONCLUSION Vascular uptake on 18F-FDG PET/CT and the presence of NIH criterion 2 are associated with future relapse in patients with clinically inactive TAK.
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Affiliation(s)
- Oh Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Joo Jeon
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Baalbaki H, Jalaledin D, Lachance C, Febrer G, Rhéaume M, Makhzoum JP. Characterization of visual manifestations and identification of risk factors for permanent vision loss in patients with giant cell arteritis. Clin Rheumatol 2021; 40:3207-3217. [PMID: 33580374 DOI: 10.1007/s10067-021-05643-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/31/2021] [Accepted: 02/07/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/PURPOSE Permanent vision loss (PVL) is a feared complication and a leading cause of morbidity in giant cell arteritis (GCA). The objective of this study is to describe visual manifestations and identify risk factors of ocular involvement in GCA. METHODS A retrospective database from a single vasculitis referral center was used. Descriptive statistics comparing patients with and without ocular involvement were performed. RESULTS One hundred patients with GCA were included. Visual symptoms were present in 53% of patients at diagnosis and included blurred vision (30%), diplopia (16%), amaurosis fugax (14%), and blindness (19%). Out of 19 patients with blindness, 16 did not recover and had PVL. Patients with PVL were older (79.2 ± 6.7 vs 74.2 ± 7.6 years; p = 0.008) and more likely to have coronary artery disease (31% vs 10%; p = 0.018). However, they were less likely to have other cranial symptoms (81% vs 96%; p = 0.019), mainly headaches (64% vs 92%; p = 0.003). Risk factors associated with an abnormal ophthalmologic examination were the same as for PVL, but patients were also more likely to have diabetes (29% vs 7%; p = 0.040) and less likely to have constitutional symptoms (53% vs 80%; p = 0.033). CONCLUSION Patients with GCA and ocular involvement were more likely to have baseline diabetes and atherosclerosis. A predisposing vascular vulnerability might therefore increase the risk of ocular involvement. Key points • Most patients with GCA and complete vision loss at presentation will not recover and evolve to have permanent vision loss. • A GCA patient with visual manifestations at presentation has more baseline vascular risk factors (diabetes, atherosclerosis) than patients without ocular involvement. • Patients with GCA and visual manifestations have fewer constitutional symptoms and lower inflammatory markers than patients without ocular involvement.
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Affiliation(s)
- Hussein Baalbaki
- Vasculitis Clinic, Canadian Network for Research on Vasculitides (CanVasc), Division of Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Darya Jalaledin
- Department of Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Guillaume Febrer
- Division of Vascular Surgery, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Maxime Rhéaume
- Vasculitis Clinic, Canadian Network for Research on Vasculitides (CanVasc), Division of Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Jean-Paul Makhzoum
- Vasculitis Clinic, Canadian Network for Research on Vasculitides (CanVasc), Division of Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada.
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13
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Sağer MS, Bilgiç S, Uslu L, Asa S, Sağer G, Sönmezoğlu K. Active Giant Cell Vasculitis Diagnosis with 68Ga PSMA PET/CT Imaging. Mol Imaging Radionucl Ther 2021; 30:57-59. [PMID: 33586411 PMCID: PMC7885283 DOI: 10.4274/mirt.galenos.2019.90532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Vasculitis is a multisystem disease characterized by inflammation with infiltration of leukocytes into the blood vessels. Giant cell arteritis (GCA) is the most common form of vasculitis that mostly affects medium- and large-sized arteries. 18Fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is increasingly used to diagnose inflammation of large arteries in GCA. Galium-68 prostate-specific membrane antigen (PSMA) PET/CT has a vital role in the assessment of patients with prostate cancer for recurrence and metastasis of the disease. Various benign and non-prostate malignant conditions may give rise to increased PSMA uptake. Herein, we demonstrate that PSMA uptake can be seen in GCA.
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Affiliation(s)
- Muhammet Sait Sağer
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey
| | - Seçkin Bilgiç
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey
| | - Lebriz Uslu
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey
| | - Sertaç Asa
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey
| | - Güneş Sağer
- Kartal Dr. Lütfi Kırdar City Hospital, Clinic of Pediatry, İstanbul, Turkey
| | - Kerim Sönmezoğlu
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey
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14
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15
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Ben Shimol J, Amital H, Lidar M, Domachevsky L, Shoenfeld Y, Davidson T. The utility of PET/CT in large vessel vasculitis. Sci Rep 2020; 10:17709. [PMID: 33077771 PMCID: PMC7572466 DOI: 10.1038/s41598-020-73818-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022] Open
Abstract
18F-FDG PET/CT occupies a growing role in the diagnosis of large vessel vasculitis (LVV), illustrating enhanced uptake in the lining of large vessels. A retrospective single center study was conducted of patients who underwent 18F-FDG PET/CT scans between 2009 and 2019 at Sheba Medical Center, Israel. The imaging results were analyzed for evidence of LVV. We reviewed the PET/CT scans of 126 patients and identified 57 studies that either showed evidence of active LVV or that had been performed in patients previously treated for systemic vasculitis. In 6 patients with fevers of unknown origin and elevated inflammatory markers, PET/CT revealed LVV. Six of 13 patients previously treated for systemic vasculitis demonstrated persistent large vessel uptake. LVV was identified in 8 patients with other autoimmune diseases, and in 4 diagnosed with infectious aortitis. In 26 patients who underwent malignancy surveillance, PET/CT revealed more localized large vessel wall inflammation. Our results illustrate that PET/CT may identify large vessel wall inflammation in patients with a suspicion of LVV, and incidentally in patients who undergo malignancy surveillance. PET/CT may also help delineate the presence and extent of vessel inflammation in patients with LVV and in those with other autoimmune diseases.
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Affiliation(s)
- Jennifer Ben Shimol
- Department of Medicine, E. Wolfson Medical Center, Holon, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Howard Amital
- Department of Medicine, 'B' and Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Saint Petersburg Research Institute of Phthisiopulmonology, Saint-Petersburg, Russian Federation
| | - Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Nguyen AD, Crowhurst T, Lester S, Dobson R, Bartholomeusz D, Hill C. The utility of fluorine-18-fluorodeoxyglucose positron emission tomography in the diagnosis and monitoring of large vessel vasculitis: A South Australian retrospective audit. Int J Rheum Dis 2019; 22:1378-1382. [DOI: 10.1111/1756-185x.13617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/12/2019] [Accepted: 05/09/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Ai Duyen Nguyen
- Department of Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Thomas Crowhurst
- Department of Thoracic Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Susan Lester
- Rheumatology Unit; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Rheumatology Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Rachael Dobson
- Department of Nuclear Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Dylan Bartholomeusz
- Department of Nuclear Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Catherine Hill
- Rheumatology Unit; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Rheumatology Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
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17
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Farrah TE, Basu N, Dweck M, Calcagno C, Fayad ZA, Dhaun N. Advances in Therapies and Imaging for Systemic Vasculitis. Arterioscler Thromb Vasc Biol 2019; 39:1520-1541. [PMID: 31189432 DOI: 10.1161/atvbaha.118.310957] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Vasculitis is a systemic disease characterized by immune-mediated injury of blood vessels. Current treatments for vasculitis, such as glucocorticoids and alkylating agents, are associated with significant side effects. Furthermore, the management of both small and large vessel vasculitis is challenging because of a lack of robust markers of disease activity. Recent research has advanced our understanding of the pathogenesis of both small and large vessel vasculitis, and this has led to the development of novel biologic therapies capable of targeting key cytokine and cellular effectors of the inflammatory cascade. In parallel, a diverse range of imaging modalities with the potential to monitor vessel inflammation are emerging. Continued expansion of combined structural and molecular imaging using positron emission tomography with computed tomography or magnetic resonance imaging may soon provide reliable longitudinal tracking of vascular inflammation. In addition, the emergence of radiotracers able to assess macrophage activation and immune checkpoint activity represents an exciting new frontier in imaging vascular inflammation. In the near future, these advances will allow more precise imaging of disease activity enabling clinicians to offer more targeted and individualized patient management.
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Affiliation(s)
- Tariq E Farrah
- From the University/British Heart Foundation Centre of Research Excellence, Centre of Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Scotland (T.E.F., M.D., N.D.)
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Scotland (N.B.)
| | - Marc Dweck
- From the University/British Heart Foundation Centre of Research Excellence, Centre of Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Scotland (T.E.F., M.D., N.D.)
| | - Claudia Calcagno
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (C.C., Z.A.F.)
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (C.C., Z.A.F.)
| | - Neeraj Dhaun
- From the University/British Heart Foundation Centre of Research Excellence, Centre of Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Scotland (T.E.F., M.D., N.D.)
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18
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Kim J, Song HC. Role of PET/CT in the Evaluation of Aortic Disease. Chonnam Med J 2018; 54:143-152. [PMID: 30288369 PMCID: PMC6165921 DOI: 10.4068/cmj.2018.54.3.143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 01/18/2023] Open
Abstract
Positron emission tomography (PET) /computed tomography (CT) has been established as a standard imaging modality in the evaluation of malignancy. Although PET/CT has played a major role in the management of oncology patients, its clinical use has also increased for various disorders other than malignancy. Growing evidence shows that PET/CT images have many advantages in aortic disease as well. This review article addresses the potential role of PET/CT in diseases involving the aorta, emphasizing its usefulness with regard to acute thoracic aortic syndromes, aortic aneurysm, atherosclerotic lesions, aortitis and aortic tumors.
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Affiliation(s)
- Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea.,Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Korea
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19
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Shahi F, Samson A. Positron emission tomography and reframing vasculitis as a spectrum of disease when investigating a patient with a fever of unknown origin. BMJ Case Rep 2018; 2018:bcr-2018-224540. [PMID: 30232201 DOI: 10.1136/bcr-2018-224540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A retired businessman presented to the infectious diseases department with a history of ongoing fevers and myalgia and raised inflammatory markers. This continued despite adequate antibiotic treatment of an epididymo-orchitis. Extensive investigations, including bone marrow and liver biopsies and a positron emission tomography, did not reveal a cause but showed reactive change in the bone marrow. Later, he developed a vasculitic rash and vision loss due to non-arteritic anterior ischaemic optic neuropathy. High-dose steroids were immediately initiated. A temporal artery biopsy was performed, which confirmed a healing large vessel vasculitis, possibly giant cell arteritis. He has responded very well to therapy. We must better appreciate the limitations of positron emission tomography in investigating a fever of unknown origin. The case also encourages awareness of autoimmune disorders as the leading category of causative diseases for this in older age groups.
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Affiliation(s)
- Farah Shahi
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Anda Samson
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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20
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18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography for the Diagnosis of Large Vessel Vasculitis Associated With Malignancy: A Case of Large Vessel Vasculitis Associated With Neuroendocrine Carcinoma of the Duodenum. J Clin Rheumatol 2018; 25:e98-e101. [PMID: 30211756 DOI: 10.1097/rhu.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Koster MJ, Matteson EL, Warrington KJ. Large-vessel giant cell arteritis: diagnosis, monitoring and management. Rheumatology (Oxford) 2018; 57:ii32-ii42. [PMID: 29982778 DOI: 10.1093/rheumatology/kex424] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 11/14/2022] Open
Abstract
GCA is a chronic, idiopathic, granulomatous vasculitis of medium and large arteries. It comprises overlapping phenotypes including classic cranial arteritis and extra-cranial GCA, otherwise termed large-vessel GCA (LV-GCA). Vascular complications associated with LV-GCA may be due, in part, to delayed diagnosis, highlighting the importance of early identification and prompt initiation of effective therapy. Advancements in imaging techniques, including magnetic resonance angiography, CT angiography, PET and colour duplex ultrasonography, have led to improvements in the diagnosis of LV-GCA; however, the role imaging modalities play in the assessment of disease activity and long-term outcomes remains unclear. Glucocorticoids are the mainstay of therapy in LV-GCA, but their prolonged use is associated with multiple, sometimes serious, adverse effects. Recent data suggest that biologic therapies, such as tocilizumab, may be effective and safe steroid-sparing options for patients with GCA. However, data specifically evaluating the management of LV-GCA are limited.
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22
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Mohamed R, Djama D, Ayoub T. Diagnostic positron emission tomography-computed tomography in clinically elusive giant cell arteritis. Indian J Ophthalmol 2018; 66:693-694. [PMID: 29676318 PMCID: PMC5939166 DOI: 10.4103/ijo.ijo_998_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ryian Mohamed
- Department of Head & Neck, University College London Hospitals NHS Trust, London, UK
| | - Deyl Djama
- Undergraduate Student, Kings College London, London, UK
| | - Tariq Ayoub
- Department of Ophthalmology, Royal Free Hospitals NHS Foundation Trust, London, UK
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23
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Olthof SC, Krumm P, Henes J, Nikolaou K, la Fougère C, Pfannenberg C, Schwenzer N. Imaging giant cell arteritis and Aortitis in contrast enhanced 18F-FDG PET/CT: Which imaging score correlates best with laboratory inflammation markers? Eur J Radiol 2018; 99:94-102. [DOI: 10.1016/j.ejrad.2017.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/15/2017] [Accepted: 12/26/2017] [Indexed: 01/06/2023]
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24
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Rayudu AL, Kalawat T, Krishna Mohan VS, Mohan A, Lakshmi AY, Mantri RG. 18F-Fluorodeoxyglucose Positron Emission Tomography-computed Tomography in Evaluation of Large Vessel Vasculitis. Indian J Nucl Med 2018; 33:48-51. [PMID: 29430115 PMCID: PMC5798098 DOI: 10.4103/ijnm.ijnm_114_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) is a rapidly evolving hybrid imaging technique in evaluation of infection and inflammation. Usually, functional changes often precede anatomical changes. 18F-FDG PET-CT, a noninvasive diagnostic test and it is useful for the early detection of inflammation. Most of the large vessel vasculitis patients present with nonspecific signs and symptoms, which are difficult to diagnose clinically. Here, we discuss three cases of large vessel vasculitis with different clinical presentations, identified by 18F-FDG PET-CT scan.
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Affiliation(s)
| | - Tekchand Kalawat
- Department of Nuclear Medicine, SVIMS, Tirupati, Andhra Pradesh, India
| | - VS Krishna Mohan
- Department of Nuclear Medicine, SVIMS, Tirupati, Andhra Pradesh, India
| | - A Mohan
- Department of Medicine, SVIMS, Tirupati, Andhra Pradesh, India
| | | | - Ranadheer Gupta Mantri
- Department of Nuclear Medicine, SVIMS, Tirupati, Andhra Pradesh, India,Address for correspondence: Dr. Ranadheer Gupta, Department of Nuclear Medicine, SVIMS, Tirupati - 517 507, Andhra Pradesh, India. E-mail:
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D’Aguanno V, Ralli M, de Vincentiis M, Greco A. Optimal management of Cogan's syndrome: a multidisciplinary approach. J Multidiscip Healthc 2017; 11:1-11. [PMID: 29317827 PMCID: PMC5743115 DOI: 10.2147/jmdh.s150940] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cogan's syndrome (CS) is a rare disorder characterized by nonsyphilitic interstitial keratitis (IK) and audio-vestibular symptoms. CS affects mainly young Caucasian adults, mostly during their first three decades of age, and may develop into typical and atypical variants. Typical CS manifests primarily with IK and hearing loss, whereas atypical CS usually presents with inflammatory ocular manifestations in association with audio-vestibular symptoms but mostly different Ménière-like symptoms and, more frequently, with systemic inflammation (70%), of which vasculitis is the pathogenic mechanism. CS is considered as an autoimmune- or immune-mediated disease supported mainly by the beneficial response to corticosteroids. Using well-developed assays, antibodies to inner ear antigens, anti-Hsp70, and antineutrophil cytoplasmic antibodies were found to be associated with CS. Corticosteroids represent the first line of treatment, and multiple immunosuppressive drugs have been tried with variable degrees of success. Tumor necrosis factor-alpha blockers and other biological agents are a recent novel therapeutic option in CS. Cochlear implantation is a valuable rescue surgical strategy in cases with severe sensorineural hearing loss unresponsive to intensive and/or innovative immunosuppressive regimens.
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Affiliation(s)
| | - Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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26
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Bedmutha AS, Singh N, Shivdasani D. Metabolic Imaging as a Novel Strategy in Evaluation of Mycotic Abdominal Aortic Aneurysm: A Case Report and Brief Clinical Review. Indian J Nucl Med 2017; 32:336-339. [PMID: 29142353 PMCID: PMC5672757 DOI: 10.4103/ijnm.ijnm_81_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is an uncommon entity with high mortality. Etiologically, they are classified as inflammatory and infective (mycotic), the latter being less common. Clinical presentation, laboratory investigations, and treatment for these may considerably overlap. However, choice of management and the need for surgical intervention depends on factors such as size and progression of aneurysm, persistent symptoms, and presence or absence of distant pathology. Although computed tomography (CT) is the gold standard for AAA, in selected cases, especially in infected AAA, fluorodeoxyglucose positron emission tomography-CT can provide valuable information.
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Affiliation(s)
- Akshay Sharad Bedmutha
- Department of Nuclear Medicine and PET/CT, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Natasha Singh
- Department of Nuclear Medicine and PET/CT, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Divya Shivdasani
- Department of Nuclear Medicine and PET/CT, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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27
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Clifford AH, Murphy EM, Burrell SC, Bligh MP, MacDougall RF, Heathcote JG, Castonguay MC, Lee MS, Matheson K, Hanly JG. Positron Emission Tomography/Computerized Tomography in Newly Diagnosed Patients with Giant Cell Arteritis Who Are Taking Glucocorticoids. J Rheumatol 2017; 44:1859-1866. [PMID: 28916549 DOI: 10.3899/jrheum.170138] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Large vessel uptake on positron emission tomography/computerized tomography (PET/CT) supports the diagnosis of giant cell arteritis (GCA). Its value, however, in patients without arteritis on temporal artery biopsy and in those receiving glucocorticoids remains unknown. We compared PET/CT results in GCA patients with positive (TAB+) and negative temporal artery biopsies (TAB-), and controls. METHODS Patients with new clinically diagnosed GCA starting treatment with glucocorticoids underwent temporal artery biopsy and PET/CT. Using a visual semiquantitative approach, 18F-fluorodeoxyglucose (FDG) uptake was scored in 8 vascular territories and summed overall to give a total score in patients and matched controls. RESULTS Twenty-eight patients with GCA and 28 controls were enrolled. Eighteen patients with GCA were TAB+. Mean PET/CT scores after an average of 11.9 days of prednisone were higher in patients with GCA compared to controls, for both total uptake (10.34 ± 2.72 vs 7.73 ± 2.56; p = 0.001), and in 6 of 8 specific vascular territories. PET/CT scores were similar between TAB+ and TAB- patients with GCA. The optimal cutoff for distinguishing GCA cases from controls was a total PET/CT score of ≥ 9, with an area under the receiver-operating characteristic curve of 0.75, sensitivity 71.4%, and specificity 64.3%. Among patients with GCA, these measures correlated with greater total PET/CT scores: systemic symptoms (p = 0.015), lower hemoglobin (p = 0.009), and higher platelet count (p = 0.008). CONCLUSION Vascular FDG uptake scores were increased in most patients with GCA despite exposure to prednisone; however, the sensitivity and specificity of PET/CT in this setting were lower than those previously reported.
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Affiliation(s)
- Alison H Clifford
- From the Division of Rheumatology, Department of Medicine, and the Department of Diagnostic Imaging, and the Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, and the Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority; Dalhousie University, Halifax; Department of Radiology, Valley Regional Hospital, Kentville, Nova Scotia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. .,A.H. Clifford, MD, Assistant Professor, Division of Rheumatology, University of Alberta; E.M. Murphy, MD, Assistant Professor of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; S.C. Burrell, MD, Professor of Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.P. Bligh, MD, MASc, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; R.F. MacDougall, MD, FRCPC, Department of Radiology, Valley Regional Hospital; J.G. Heathcote, MB, PhD, FRCPC, Professor of Pathology and Ophthalmology and Visual Sciences, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University; M.C. Castonguay, MD, Assistant Professor, Departments of Pathology and Laboratory Medicine and Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; K. Matheson, MSc, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.S. Lee, MD, Assistant Professor, Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University, Halifax; J.G. Hanly, MD, Professor of Medicine and Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University.
| | - Elana M Murphy
- From the Division of Rheumatology, Department of Medicine, and the Department of Diagnostic Imaging, and the Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, and the Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority; Dalhousie University, Halifax; Department of Radiology, Valley Regional Hospital, Kentville, Nova Scotia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,A.H. Clifford, MD, Assistant Professor, Division of Rheumatology, University of Alberta; E.M. Murphy, MD, Assistant Professor of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; S.C. Burrell, MD, Professor of Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.P. Bligh, MD, MASc, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; R.F. MacDougall, MD, FRCPC, Department of Radiology, Valley Regional Hospital; J.G. Heathcote, MB, PhD, FRCPC, Professor of Pathology and Ophthalmology and Visual Sciences, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University; M.C. Castonguay, MD, Assistant Professor, Departments of Pathology and Laboratory Medicine and Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; K. Matheson, MSc, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.S. Lee, MD, Assistant Professor, Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University, Halifax; J.G. Hanly, MD, Professor of Medicine and Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University
| | - Steven C Burrell
- From the Division of Rheumatology, Department of Medicine, and the Department of Diagnostic Imaging, and the Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, and the Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority; Dalhousie University, Halifax; Department of Radiology, Valley Regional Hospital, Kentville, Nova Scotia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,A.H. Clifford, MD, Assistant Professor, Division of Rheumatology, University of Alberta; E.M. Murphy, MD, Assistant Professor of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; S.C. Burrell, MD, Professor of Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.P. Bligh, MD, MASc, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; R.F. MacDougall, MD, FRCPC, Department of Radiology, Valley Regional Hospital; J.G. Heathcote, MB, PhD, FRCPC, Professor of Pathology and Ophthalmology and Visual Sciences, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University; M.C. Castonguay, MD, Assistant Professor, Departments of Pathology and Laboratory Medicine and Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; K. Matheson, MSc, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.S. Lee, MD, Assistant Professor, Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University, Halifax; J.G. Hanly, MD, Professor of Medicine and Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University
| | - Mathew P Bligh
- From the Division of Rheumatology, Department of Medicine, and the Department of Diagnostic Imaging, and the Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, and the Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority; Dalhousie University, Halifax; Department of Radiology, Valley Regional Hospital, Kentville, Nova Scotia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,A.H. Clifford, MD, Assistant Professor, Division of Rheumatology, University of Alberta; E.M. Murphy, MD, Assistant Professor of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; S.C. Burrell, MD, Professor of Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.P. Bligh, MD, MASc, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; R.F. MacDougall, MD, FRCPC, Department of Radiology, Valley Regional Hospital; J.G. Heathcote, MB, PhD, FRCPC, Professor of Pathology and Ophthalmology and Visual Sciences, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University; M.C. Castonguay, MD, Assistant Professor, Departments of Pathology and Laboratory Medicine and Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; K. Matheson, MSc, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.S. Lee, MD, Assistant Professor, Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University, Halifax; J.G. Hanly, MD, Professor of Medicine and Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University
| | - Ryan F MacDougall
- From the Division of Rheumatology, Department of Medicine, and the Department of Diagnostic Imaging, and the Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, and the Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority; Dalhousie University, Halifax; Department of Radiology, Valley Regional Hospital, Kentville, Nova Scotia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,A.H. Clifford, MD, Assistant Professor, Division of Rheumatology, University of Alberta; E.M. Murphy, MD, Assistant Professor of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; S.C. Burrell, MD, Professor of Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.P. Bligh, MD, MASc, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; R.F. MacDougall, MD, FRCPC, Department of Radiology, Valley Regional Hospital; J.G. Heathcote, MB, PhD, FRCPC, Professor of Pathology and Ophthalmology and Visual Sciences, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University; M.C. Castonguay, MD, Assistant Professor, Departments of Pathology and Laboratory Medicine and Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; K. Matheson, MSc, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.S. Lee, MD, Assistant Professor, Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University, Halifax; J.G. Hanly, MD, Professor of Medicine and Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University
| | - J Godfrey Heathcote
- From the Division of Rheumatology, Department of Medicine, and the Department of Diagnostic Imaging, and the Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, and the Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority; Dalhousie University, Halifax; Department of Radiology, Valley Regional Hospital, Kentville, Nova Scotia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,A.H. Clifford, MD, Assistant Professor, Division of Rheumatology, University of Alberta; E.M. Murphy, MD, Assistant Professor of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; S.C. Burrell, MD, Professor of Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.P. Bligh, MD, MASc, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; R.F. MacDougall, MD, FRCPC, Department of Radiology, Valley Regional Hospital; J.G. Heathcote, MB, PhD, FRCPC, Professor of Pathology and Ophthalmology and Visual Sciences, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University; M.C. Castonguay, MD, Assistant Professor, Departments of Pathology and Laboratory Medicine and Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; K. Matheson, MSc, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.S. Lee, MD, Assistant Professor, Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University, Halifax; J.G. Hanly, MD, Professor of Medicine and Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University
| | - Mathieu C Castonguay
- From the Division of Rheumatology, Department of Medicine, and the Department of Diagnostic Imaging, and the Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, and the Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority; Dalhousie University, Halifax; Department of Radiology, Valley Regional Hospital, Kentville, Nova Scotia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,A.H. Clifford, MD, Assistant Professor, Division of Rheumatology, University of Alberta; E.M. Murphy, MD, Assistant Professor of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; S.C. Burrell, MD, Professor of Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.P. Bligh, MD, MASc, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; R.F. MacDougall, MD, FRCPC, Department of Radiology, Valley Regional Hospital; J.G. Heathcote, MB, PhD, FRCPC, Professor of Pathology and Ophthalmology and Visual Sciences, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University; M.C. Castonguay, MD, Assistant Professor, Departments of Pathology and Laboratory Medicine and Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; K. Matheson, MSc, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.S. Lee, MD, Assistant Professor, Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University, Halifax; J.G. Hanly, MD, Professor of Medicine and Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University
| | - Min S Lee
- From the Division of Rheumatology, Department of Medicine, and the Department of Diagnostic Imaging, and the Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, and the Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority; Dalhousie University, Halifax; Department of Radiology, Valley Regional Hospital, Kentville, Nova Scotia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,A.H. Clifford, MD, Assistant Professor, Division of Rheumatology, University of Alberta; E.M. Murphy, MD, Assistant Professor of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; S.C. Burrell, MD, Professor of Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.P. Bligh, MD, MASc, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; R.F. MacDougall, MD, FRCPC, Department of Radiology, Valley Regional Hospital; J.G. Heathcote, MB, PhD, FRCPC, Professor of Pathology and Ophthalmology and Visual Sciences, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University; M.C. Castonguay, MD, Assistant Professor, Departments of Pathology and Laboratory Medicine and Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; K. Matheson, MSc, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.S. Lee, MD, Assistant Professor, Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University, Halifax; J.G. Hanly, MD, Professor of Medicine and Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University
| | - Kara Matheson
- From the Division of Rheumatology, Department of Medicine, and the Department of Diagnostic Imaging, and the Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, and the Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority; Dalhousie University, Halifax; Department of Radiology, Valley Regional Hospital, Kentville, Nova Scotia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,A.H. Clifford, MD, Assistant Professor, Division of Rheumatology, University of Alberta; E.M. Murphy, MD, Assistant Professor of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; S.C. Burrell, MD, Professor of Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.P. Bligh, MD, MASc, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; R.F. MacDougall, MD, FRCPC, Department of Radiology, Valley Regional Hospital; J.G. Heathcote, MB, PhD, FRCPC, Professor of Pathology and Ophthalmology and Visual Sciences, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University; M.C. Castonguay, MD, Assistant Professor, Departments of Pathology and Laboratory Medicine and Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; K. Matheson, MSc, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.S. Lee, MD, Assistant Professor, Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University, Halifax; J.G. Hanly, MD, Professor of Medicine and Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University
| | - John G Hanly
- From the Division of Rheumatology, Department of Medicine, and the Department of Diagnostic Imaging, and the Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, and the Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority; Dalhousie University, Halifax; Department of Radiology, Valley Regional Hospital, Kentville, Nova Scotia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,A.H. Clifford, MD, Assistant Professor, Division of Rheumatology, University of Alberta; E.M. Murphy, MD, Assistant Professor of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; S.C. Burrell, MD, Professor of Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.P. Bligh, MD, MASc, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; R.F. MacDougall, MD, FRCPC, Department of Radiology, Valley Regional Hospital; J.G. Heathcote, MB, PhD, FRCPC, Professor of Pathology and Ophthalmology and Visual Sciences, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University; M.C. Castonguay, MD, Assistant Professor, Departments of Pathology and Laboratory Medicine and Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; K. Matheson, MSc, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University; M.S. Lee, MD, Assistant Professor, Division of Vascular Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University, Halifax; J.G. Hanly, MD, Professor of Medicine and Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, and Dalhousie University
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Frary EC, Hess S, Gerke O, Laustrup H. 18F-fluoro-deoxy-glucose positron emission tomography combined with computed tomography can reliably rule-out infection and cancer in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis suspected of disease relapse. Medicine (Baltimore) 2017; 96:e7613. [PMID: 28746217 PMCID: PMC5627843 DOI: 10.1097/md.0000000000007613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of autoimmune diseases characterized by systemic inflammation in small- to medium-sized blood vessels. Although immunosuppressive therapy has greatly improved the prognosis for these patients, there are still significant comorbidities, such as cancer and infection, associated with AAV. These comorbidities are often indistinguishable from an underlying AAV disease relapse, and create a clinical conundrum, as these conditions are normally contraindications for immunosuppressive treatment. Thus, it is important to be able to rule out these comorbidities before initiation of immunosuppressive treatment. We examined F-fluoro-deoxy-glucose positron emission tomography combined with computed tomography (FDG-PET/CT)'s value in ruling out cancer or infection in patients with AAV.Data were obtained retrospectively for a clinically based cohort of AAV patients who underwent FDG-PET/CT during 2009 to 2014 owing to a suspicion of cancer, infection, or both cancer and infection indistinguishable from disease relapse. FDG-PET/CT conclusions were compared to the final diagnoses after follow-up analysis (mean 43 months).A total of 19 patients were included who underwent a total of 26 scans. The results of FDG-PET/CT outcome compared to final diagnosis were: 9 true positives, 3 false positives, 13 true negatives, and 1 false negative. The diagnostic probabilities for FDG-PET/CT with respect to overall comorbidity (i.e., cancer or infection) were: sensitivity 90% ( 95% confidence interval [CI] 60%-98%), specificity 81% ( 95% CI 57%-93%), positive predictive value 75% (95% CI 47%-91%), negative predictive value 93% (95% CI 68%-99%), and accuracy 84% (95% CI 66%-94%).FDG-PET/CT had a high negative predictive value and ruled out the comorbidities correctly in all but one case of urinary tract infection, a well-known limitation. Our study showed FGD-PET/CT's promise as an effective tool for ruling out cancer or infection in patients with AAV albeit in a limited population.
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Affiliation(s)
- Evan C. Frary
- Department of Nuclear Medicine, Odense University Hospital, Odense C
| | - Søren Hess
- Department of Nuclear Medicine, Odense University Hospital, Odense C
- Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Esbjerg
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense C
- Center of Health Economics Research, University of Southern Denmark, Odense M
| | - Helle Laustrup
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C
- Department of Rheumatology, Odense University Hospital, Odense C, Denmark
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Bhattarai A, Nakajima T, Sapkota S, Arisaka Y, Tokue A, Yonemoto Y, Tsushima Y. Diagnostic value of 18F-fluorodeoxyglucose uptake parameters to differentiate rheumatoid arthritis from other types of arthritis. Medicine (Baltimore) 2017; 96:e7130. [PMID: 28640086 PMCID: PMC5484194 DOI: 10.1097/md.0000000000007130] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We aimed evaluate F-fluorodeoxyglucose uptake at major joints for differentiating patients with rheumatoid arthritis (RA) from those with non-RA arthritis using F-fluorodeoxyglucose (FDG)-positron emission tomography (PET).Eighteen patients with RA (13 women; age, 66.8 ± 13.2 years) and 17 patients with non-RA (6 women; age, 50.8 ± 12.5 years) were included. Twelve joints of each patient were examined: shoulder, elbow, wrist, hip, knee, and ankle on both sides. A visual scoring (VS) system was used; quantitative parameters such as maximum standardized uptake value (SUVmax), metabolic active volume (MAV), and total lesion glycolysis (TLG) were evaluated. Total score and value of each parameter were compared between the RA and non-RA groups.Total VS score (mean, 37.7 ± 9.0 vs 21.9 ± 7.2; P < .0001) and SUVmax (mean, 28.1 ± 8.5 vs 17.9 ± 5.8; P < .001) were significantly higher in the RA group than in the non-RA group. A significant between-group difference was also observed with respect to total MAV (608.3 ± 370.7 vs 176.5 ± 217.8; P < .001) and total TLG (1139.3 ± 759.1 vs 289.5 ± 395.4; P < .001). Receiver operating characteristic curve analysis revealed that total VS had the highest area under curve (.92), with sensitivity and specificity of 88.9% and 76.4%, respectively.Quantitative PET parameters could differentiate RA from non-RA. Total VS score, however, appears to be the best convenient qualitative tool for diagnosing RA.
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Affiliation(s)
- Anu Bhattarai
- Department of Diagnostic Radiology and Nuclear Medicine
| | | | | | | | - Azusa Tokue
- Department of Diagnostic Radiology and Nuclear Medicine
| | - Yukio Yonemoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine
- Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Gunma, Japan
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"To be or not to be" for PET in rheumatology. A marriage of love or of convenience? Reumatologia 2017; 55:1-3. [PMID: 28386135 PMCID: PMC5380765 DOI: 10.5114/reum.2017.66679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/27/2017] [Indexed: 11/17/2022] Open
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Alarcón García JC, Rodríguez Suárez S, Muñiz Grijalvo O, García Morillo S. Vascular lesions in patient with Takayasu arteritis and massive elevated lipoprotein(a) levels. Residual involvement or premature aterosclerosis? CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:98-102. [PMID: 28188021 DOI: 10.1016/j.arteri.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/22/2016] [Accepted: 10/28/2016] [Indexed: 02/05/2023]
Abstract
Lipoprotein (a) [Lp(a)] is a lipoprotein defined by presenting a specific apolipoprotein, ApoA, linked to the ApoB-100 by different types of chemical bonds, including a disulfide bridge. Despite their atherogenic mechanism is not fully understood, its importance has been demonstrated in the development of premature aterosclerosis. Multiple studies have shown its role as a cardiovascular risk factor associated with heart disease and stroke. We report the case of a patient with a diagnosis of Takayasu arteritis in which a massive elevation of Lp(a) was detected. We emphasize its diagnostic and therapeutic implications.
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Affiliation(s)
- José Carlos Alarcón García
- Unidad de Colagenosis y Enfermedades Minoritarias, Unidad Experimental de Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - Santiago Rodríguez Suárez
- Unidad de Colagenosis y Enfermedades Minoritarias, Unidad Experimental de Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Ovidio Muñiz Grijalvo
- Unidad de Colagenosis y Enfermedades Minoritarias, Unidad Experimental de Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Salvador García Morillo
- Unidad de Colagenosis y Enfermedades Minoritarias, Unidad Experimental de Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España
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Rehak Z, Vasina J, Ptacek J, Kazda T, Fojtik Z, Nemec P. PET/CT in giant cell arteritis: High 18F-FDG uptake in the temporal, occipital and vertebral arteries. Rev Esp Med Nucl Imagen Mol 2016; 35:398-401. [PMID: 27177856 DOI: 10.1016/j.remn.2016.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/14/2016] [Accepted: 03/24/2016] [Indexed: 11/17/2022]
Abstract
18F-FDG PET/CT imaging is useful in patients with fever of unknown origin and can detect giant cell arteritis in extracranial large arteries. However, it is usually assumed that temporal arteries cannot be visualized with a PET/CT scanner due to their small diameter. Three patients with clinical symptoms of temporal arteritis were examined using a standard whole body PET/CT protocol (skull base - mid thighs) followed by a head PET/CT scan using the brain protocol. High 18F-FDG uptake in the aorta and some arterial branches were detected in all 3 patients with the whole body protocol. Using the brain protocol, head imaging led to detection of high 18F-FDG uptake in temporal arteries as well as in their branches (3 patients), in occipital arteries (2 patients) and also in vertebral arteries (3 patients).
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Affiliation(s)
- Z Rehak
- Department of Nuclear Medicine and PET Center, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Regional Center for Applied Molecular Oncology (RECAMO), Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - J Vasina
- Department of Nuclear Medicine and PET Center, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Center of Molecular Imaging, International Clinical Research Center (ICRC), St. Anne's University Hospital, Brno, Czech Republic
| | - J Ptacek
- Department of Nuclear Medicine and Department of Medical Physics and Radiation Protection, University Hospital, Olomouc, Czech Republic
| | - T Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Z Fojtik
- Rheumatology Unit, Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - P Nemec
- Rheumatology Unit, 2nd Department of Internal Medicine, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Rehak Z, Vasina J, Ptacek J, Kazda T, Fojtik Z, Nemec P. PET/CT in giant cell arteritis: High 18F-FDG uptake in the temporal, occipital and vertebral arteries. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chalian H, O'Donnell JK, Bolen M, Rajiah P. Incremental value of PET and MRI in the evaluation of cardiovascular abnormalities. Insights Imaging 2016; 7:485-503. [PMID: 27221975 PMCID: PMC4956622 DOI: 10.1007/s13244-016-0494-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/01/2016] [Accepted: 04/22/2016] [Indexed: 12/11/2022] Open
Abstract
Abstract The cardiovascular system is affected by a wide range of pathological processes, including neoplastic, inflammatory, ischemic, and congenital aetiology. Magnetic resonance imaging (MRI) and positron emission tomography (PET) are state-of-the-art imaging modalities used in the evaluation of these cardiovascular disorders. MRI has good spatial and temporal resolutions, tissue characterization and multi-planar imaging/reconstruction capabilities, which makes it useful in the evaluation of cardiac morphology, ventricular and valvar function, disease characterization, and evaluation of myocardial viability. FDG-PET provides valuable information on the metabolic activity of the cardiovascular diseases, including ischemia, inflammation, and neoplasm. MRI and FDG-PET can provide complementary information on the evaluation of several cardiovascular disorders. For example, in cardiac masses, FDG-PET provides the metabolic information for indeterminate cardiac masses. MRI can be used for localizing and characterizing abnormal hypermetabolic foci identified incidentally on PET scan and also for local staging. A recent advance in imaging technology has been the development of integrated PET/MRI systems that utilize the advantages of PET and MRI in a single examination. The goal of this manuscript is to provide a comprehensive review on the incremental value of PET and MRI in the evaluation of cardiovascular diseases. Main Messages • MRI has good spatial and temporal resolutions, tissue characterization, and multi-planar reconstruction • FDG-PET provides valuable information on the metabolic activity of cardiovascular disorders • PET and MRI provide complementary information on the evaluation of cardiovascular disorders Electronic supplementary material The online version of this article (doi:10.1007/s13244-016-0494-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hamid Chalian
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - James K O'Donnell
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Michael Bolen
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Prabhakar Rajiah
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA. .,Cardiothoracic Imaging, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390, USA.
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Blockmans D. Use of FDG-PET Scan for the Assessment of Large Vessel Vasculitis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2016. [DOI: 10.1007/s40674-016-0044-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Loricera J, Blanco R, Hernández J, Martínez-Rodríguez I, Carril J, Lavado C, Jiménez M, González-Vela C, González-Gay M. Use of positron emission tomography (PET) for the diagnosis of large-vessel vasculitis. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Use of positron emission tomography (PET) for the diagnosis of large-vessel vasculitis. Rev Esp Med Nucl Imagen Mol 2015; 34:372-7. [PMID: 26272121 DOI: 10.1016/j.remn.2015.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
The term vasculitis encompasses a heterogeneous group of diseases that share the presence of inflammatory infiltrates in the vascular wall. The diagnosis of large-vessel vasculitis is often a challenge because the presenting clinical features are nonspecific in many cases and they are often shared by different types of autoimmune and inflammatory diseases including other systemic vasculitides. Moreover, the pathogenesis of large-vessel vasculitis is not fully understood. Nevertheless, the advent of new imaging techniques has constituted a major breakthrough to establish an early diagnosis and a promising tool to monitor the follow-up of patients with largevessel vasculitis. This is the case of the molecular imaging with the combination of positron emission tomography with computed tomography (PET/CT) using different radiotracers, especially the (18)F-fluordeoxyglucose ((18)F-FDG). In this review we have focused on the contribution of (18)F-FDG PET in the diagnosis of large-vessel vasculitis.
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The prognostic value of baseline 18F-FDG PET/CT in steroid-naïve large-vessel vasculitis: introduction of volume-based parameters. Eur J Nucl Med Mol Imaging 2015; 43:340-348. [DOI: 10.1007/s00259-015-3148-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
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Danve A, O'Dell J. The Role of 18F Fluorodeoxyglucose Positron Emission Tomography Scanning in the Diagnosis and Management of Systemic Vasculitis. Int J Rheum Dis 2015; 18:714-24. [DOI: 10.1111/1756-185x.12713] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Abhijeet Danve
- Division of Rheumatology; University of Nebraska Medical Center; Omaha Nebraska USA
| | - James O'Dell
- Division of Rheumatology; University of Nebraska Medical Center; Omaha Nebraska USA
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Guleria A, Misra DP, Rawat A, Dubey D, Khetrapal CL, Bacon P, Misra R, Kumar D. NMR-Based Serum Metabolomics Discriminates Takayasu Arteritis from Healthy Individuals: A Proof-of-Principle Study. J Proteome Res 2015; 14:3372-81. [PMID: 26081138 DOI: 10.1021/acs.jproteome.5b00422] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Takayasu arteritis (TA) is a debilitating, systemic disease that involves the aorta and large arteries in a chronic inflammatory process that leads to vessel stenosis. Initially, the disease remains clinically silent (or remains undetected) until the patients present with vascular occlusion. Therefore, new methods for appropriate and timely diagnosis of TA cases are needed to start proper therapy on time and also to monitor the patient's response to the given treatment. In this context, NMR-based serum metabolomic profiling has been explored in this proof-of-principle study for the first time to determine characteristic metabolites that could be potentially helpful for diagnosis and prognosis of TA. Serum metabolic profiling of TA patients (n = 29) and healthy controls (n = 30) was performed using 1D (1)H NMR spectroscopy, and possible biomarker metabolites were identified. Using projection to least-squares discriminant analysis, we could distinguish TA patients from healthy controls. Compared to healthy controls, TA patients had (a) increased serum levels of choline metabolites, LDL cholesterol, N-acetyl glycoproteins (NAGs), and glucose and (b) decreased serum levels of lactate, lipids, HDL cholesterol, and glucogenic amino acids. The results of this study are preliminary and need to be confirmed in a prospective study.
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Affiliation(s)
- Anupam Guleria
- †Centre of Biomedical Research and ‡Department of Immunology, SGPGIMS, Lucknow, 226014 Uttar Pradesh, India.,§Rheumatology Research Group, Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Durga Prasanna Misra
- †Centre of Biomedical Research and ‡Department of Immunology, SGPGIMS, Lucknow, 226014 Uttar Pradesh, India.,§Rheumatology Research Group, Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Atul Rawat
- †Centre of Biomedical Research and ‡Department of Immunology, SGPGIMS, Lucknow, 226014 Uttar Pradesh, India.,§Rheumatology Research Group, Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Durgesh Dubey
- †Centre of Biomedical Research and ‡Department of Immunology, SGPGIMS, Lucknow, 226014 Uttar Pradesh, India.,§Rheumatology Research Group, Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Chunni Lal Khetrapal
- †Centre of Biomedical Research and ‡Department of Immunology, SGPGIMS, Lucknow, 226014 Uttar Pradesh, India.,§Rheumatology Research Group, Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Paul Bacon
- †Centre of Biomedical Research and ‡Department of Immunology, SGPGIMS, Lucknow, 226014 Uttar Pradesh, India.,§Rheumatology Research Group, Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Ramnath Misra
- †Centre of Biomedical Research and ‡Department of Immunology, SGPGIMS, Lucknow, 226014 Uttar Pradesh, India.,§Rheumatology Research Group, Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Dinesh Kumar
- †Centre of Biomedical Research and ‡Department of Immunology, SGPGIMS, Lucknow, 226014 Uttar Pradesh, India.,§Rheumatology Research Group, Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, United Kingdom
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