Meller J, Grabbe E, Becker W, Vosshenrich R
Department of Nuclear Medicine, Georg August University, Robert Koch Strasse 40, 37075 Göttingen, Germany.
Eur Radiol. 2003 Feb;13(2):400-5. doi: 10.1007/s00330-002-1518-8. Epub 2002 Jun 29.
Takayasu aortitis (TA) is a chronic inflammatory and fibrotic vasculitis of large- and medium-sized arteries. Early stages of the disease show a panarteritis and inflammatory wall thickening of the aorta and its branches, whereas advanced (fibrotic) stages comprise stenosis, aneurismatic transformation and occlusion. Magnetic resonance imaging visualises early-stage disease with high accuracy and is considered to be the method of choice in the diagnosis of TA. The aim of this article is the detailed comparison of FDG-PET performed with a hybrid camera and MR imaging in five patients with early TA. Five patients (median age 60 years) were enrolled during an ongoing prospective study on [18F]2'-deoxy-2-fluoro-D-glucose (FDG) hybrid camera PET in patients with fever of unknown origin (FUO). These patients underwent MR imaging after establishing the diagnosis of TA. Abnormal FDG uptake in the wall of the aorta was noted in all patients. The bracheocephalic artery and the common carotid arteries were visualized in 3 cases. Increased uptake of the subclavian artery was found in 3 patients and in 4 patients pathological uptake was noted in the ilio-femoral vessels. Of 34 vascular regions studied, 26 (76%) showed elevated FDG uptake. On transversal MR images vessel wall thickening and contrast enhancement of the thoracic aorta was found in 4 patients (ascending aorta/aortic arch: n=2; descending aorta: n=3; abdominal aorta: n=1). Additionally, vessel wall pathologies of the subclavian and the common carotid arteries could be shown in 1 patient and in another patient in the ilio-femoral arteries. No abnormalities were found using contrast-enhanced MR angiography. Of 28 vascular regions studied, 9 (32%) showed vasculitis on MRI. The FDG-PET is a suitable whole-body screening method in the primary diagnosis of early TA, especially in those cases with early disease that present with uncharacteristic symptoms such as FUO. Both MRI and MRA remain indispensable in the exact determination of the pathomorphological changes and in the documentation of complications such as stenosis, aneurismatic transformation and occlusion.
高安动脉炎（TA）是一种累及大、中动脉的慢性炎症性和纤维化血管炎。疾病早期表现为主动脉及其分支的全动脉炎和炎症性管壁增厚，而晚期（纤维化）阶段则包括狭窄、动脉瘤样改变和闭塞。磁共振成像能够高精度地显示疾病早期，被认为是TA诊断的首选方法。本文旨在详细比较5例早期TA患者使用混合型相机进行的FDG-PET与磁共振成像。5例患者（中位年龄60岁）入选一项正在进行的关于[18F]2'-脱氧-2-氟-D-葡萄糖（FDG）混合型相机PET在不明原因发热（FUO）患者中的前瞻性研究。这些患者在确诊TA后接受了磁共振成像检查。所有患者均发现主动脉壁FDG摄取异常。3例患者可见头臂动脉和颈总动脉。3例患者发现锁骨下动脉摄取增加，4例患者在髂股血管中发现病理性摄取。在研究的34个血管区域中，26个（76%）显示FDG摄取升高。在横断面磁共振图像上，4例患者发现胸主动脉管壁增厚和强化（升主动脉/主动脉弓：n=2；降主动脉：n=3；腹主动脉：n=1）。此外，1例患者显示锁骨下动脉和颈总动脉的血管壁病变，另1例患者显示髂股动脉的血管壁病变。对比增强磁共振血管造影未发现异常。在研究的28个血管区域中，9个（32%）在磁共振成像上显示血管炎。FDG-PET是早期TA初步诊断中一种合适的全身筛查方法，尤其是在那些以FUO等非典型症状出现的早期疾病病例中。磁共振成像和磁共振血管造影在准确确定病理形态学改变以及记录诸如狭窄、动脉瘤样改变和闭塞等并发症方面仍然不可或缺。
