Pfadenhauer K, Weinerth J, Hrdina C
Neurologische Klinik mit klinischer Neurophysiologie, Klinikum Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
Nuklearmedizin. 2011;50(1):28-32. doi: 10.3413/nukmed-0335-10-07. Epub 2010 Nov 9.
To demonstrate the capacity of FDG-PET to show active giant cell arteritis (GCA) of the extracerebral vertebral artery (VA) and to compare it with clinical, ultrasonographic (US) and biopsy findings.
PATIENTS, METHODS: Observational study of 46 consecutive patients with the diagnosis of active GCA and abnormal high FDG uptake in the aorta and other large arteries suggestive for GCA.
15 of the 46 GCA patients had abnormal high FDG uptake within the extending from the V0 to V3 segment in 13 and confined to single segments in 2 patients. In 2 patients high FDG uptake in one VA was the onIy PET abnormality. In 13 patients high FDG uptake was also found in other large arteries (carotid n = 10, subclavian/axillary artery n = 12, thoracic aorta n = 12). Abnormal PET was detectable in 5 patients despite glucocorticoid (GC) treatment. Nuchal and occipital pain and ischemic stroke or TIA in the posterior circulation (n = 3) were found in 10 patients with high VA FDG uptake. US detected halos of the V0-2 segments in 8/46 patients (5/15 VA PET positive and 3/31 VA PET negative patients). Biopsies were available in 10/15 VA PET positive patients with evidence of active GCA in 7 cases.
In patients with severe GCA and a high TVS the extracranial VA are a good target for PET imaging in active GCA with abnormal findings in 33% of patients with a positive PET. VA abnormalities can be an early and isolated finding in active GCA. PET is superior to US for the detection of active VA-GCA. A strong correlation between VA abnormalities and associated clinical abnormalities existed in 2/3 of patients. PET abnormalities of the VA could be detected in some cases after GC treatment has been started even at high doses.
证明氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示脑外椎动脉（VA）活动性巨细胞动脉炎（GCA）的能力，并将其与临床、超声（US）及活检结果进行比较。
患者、方法：对46例连续诊断为活动性GCA且主动脉及其他大动脉FDG摄取异常增高提示GCA的患者进行观察性研究。
46例GCA患者中，15例在V0至V3节段范围内FDG摄取异常增高，其中13例累及多个节段，2例局限于单个节段。2例患者仅一侧VA的FDG摄取增高是唯一的PET异常表现。13例患者在其他大动脉中也发现FDG摄取增高（颈动脉10例，锁骨下/腋动脉12例，胸主动脉12例）。尽管进行了糖皮质激素（GC）治疗，仍有5例患者PET检查结果异常。10例VA FDG摄取增高的患者出现颈部和枕部疼痛以及后循环缺血性卒中或短暂性脑缺血发作（TIA，3例）。46例患者中8例经超声检测发现V0-2节段有晕环（5例VA PET阳性患者和3例VA PET阴性患者）。15例VA PET阳性患者中有10例进行了活检，7例有活动性GCA的证据。
在重症GCA且FDG摄取增高的患者中，颅外VA是PET成像检查活动性GCA的良好靶点，PET阳性患者中33%有异常表现。VA异常可能是活动性GCA的早期孤立表现。PET在检测活动性VA-GCA方面优于超声。2/3的患者VA异常与相关临床异常之间存在强烈相关性。即使在开始高剂量GC治疗后，某些情况下仍可检测到VA的PET异常。
