Meller J, Strutz F, Siefker U, Scheel A, Sahlmann C O, Lehmann K, Conrad M, Vosshenrich R
Department of Nuclear Medicine, Georg August University, Göttingen, Germany.
Eur J Nucl Med Mol Imaging. 2003 May;30(5):730-6. doi: 10.1007/s00259-003-1144-y. Epub 2003 Apr 4.
The aim of this prospective study was to compare fluorine-18 fluorodeoxyglucose ([(18)F]FDG) positron emission tomography (PET) with magnetic resonance imaging (MRI) in patients with early aortitis, at the time of initial diagnosis and during immunosuppressive therapy. The study population consisted of 15 patients (nine females and six males; median age 62 years, range 26-76 years) who presented with fever of unknown origin or an elevated erythrocyte sedimentation rate or elevated C-reactive protein and who showed pathological aortic [(18)F]FDG uptake. Fourteen of these patients had features of early giant cell arteritis (GCA), while one had features of early Takayasu arteritis. During follow-up, seven PET scans were performed in six patients with GCA 4-30 months (median 19 months) after starting immunosuppressive medication. The results of [(18)F]FDG imaging were compared with the results of MRI at initial evaluation and during follow-up and with the clinical findings. At baseline, abnormal [(18)F]FDG uptake was present in 59/104 (56%) of the vascular regions studied in 15 patients. Seven follow-up PET studies were performed in six patients. Of 30 regions with initial pathological uptake in these patients, 24 (80%) showed normalisation of uptake during follow-up. Normalisation of [(18)F]FDG uptake correlated with clinical improvement and with normalisation of the laboratory findings. All except one of the patients with positive aortic [(18)F]FDG uptake were investigated with MRI and MRA. Thirteen of these 14 patients showed inflammation in at least one vascular region. Of 76 vascular regions studied, 41 (53%) showed vasculitis on MRI. Of 76 vascular regions studied with both PET and MRI, 47 were concordantly positive or negative on both modalities, 11 were positive on MRI only and 18 were positive on PET only. MRI was performed during follow-up in six patients: of 17 regions with inflammatory changes, 15 regions remained unchanged and two showed improvement. Whole-body [(18)F]FDG PET is valuable in the primary diagnosis of early aortitis. The results of [(18)F]FDG PET and MRI in the diagnosis of aortitis in this study were comparable, but FDG imaging identified more vascular regions involved in the inflammatory process than did MRI. In a limited number of patients [(18)F]FDG PET was more reliable than MRI in monitoring disease activity during immunosuppressive therapy.
这项前瞻性研究的目的是在早期主动脉炎患者的初始诊断时以及免疫抑制治疗期间，比较氟-18氟脱氧葡萄糖（[(18)F]FDG）正电子发射断层扫描（PET）与磁共振成像（MRI）。研究人群包括15例患者（9例女性和6例男性；中位年龄62岁，范围26 - 76岁），这些患者表现为不明原因发热或红细胞沉降率升高或C反应蛋白升高，且主动脉[(18)F]FDG摄取呈病理性。其中14例患者具有早期巨细胞动脉炎（GCA）特征，1例具有早期高安动脉炎特征。在随访期间，6例GCA患者在开始免疫抑制药物治疗后4 - 30个月（中位19个月）进行了7次PET扫描。将[(18)F]FDG成像结果与初始评估时、随访期间的MRI结果以及临床发现进行比较。基线时，15例患者研究的104个血管区域中有59个（56%）存在[(18)F]FDG摄取异常。对6例患者进行了7次随访PET研究。在这些患者最初病理性摄取的30个区域中，24个（80%）在随访期间摄取恢复正常。[(18)F]FDG摄取正常化与临床改善以及实验室检查结果正常化相关。除1例主动脉[(18)F]FDG摄取阳性的患者外，其余所有患者均接受了MRI和MRA检查。这14例患者中有13例至少在一个血管区域显示炎症。在研究的76个血管区域中，41个（53%）在MRI上显示血管炎。在同时进行PET和MRI研究的76个血管区域中，47个在两种检查方式上结果一致为阳性或阴性，11个仅在MRI上为阳性，18个仅在PET上为阳性。6例患者在随访期间进行了MRI检查：在17个有炎症改变的区域中，15个区域保持不变，2个区域显示改善。全身[(18)F]FDG PET在早期主动脉炎的初步诊断中具有重要价值。本研究中[(18)F]FDG PET和MRI在主动脉炎诊断中的结果具有可比性，但FDG成像比MRI识别出更多参与炎症过程的血管区域。在少数患者中，[(18)F]FDG PET在免疫抑制治疗期间监测疾病活动方面比MRI更可靠。
