使用完全集成的 PET/MRI 对大血管血管炎进行成像：一项初步研究。
Imaging large vessel vasculitis with fully integrated PET/MRI: a pilot study.
机构信息
Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany,
出版信息
Eur J Nucl Med Mol Imaging. 2015 Jun;42(7):1012-24. doi: 10.1007/s00259-015-3007-8. Epub 2015 Apr 16.
PURPOSE
The aim of this study was to evaluate the feasibility of hybrid [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/MRI in patients with large vessel vasculitis (LVV) by comparing visual and quantitative parameters to that of PET/CT. Furthermore, the value of PET/MRI in disease activity and extent of LVV was assessed.
METHODS
A total of 16 [(18)F]FDG PET/MRI and 12 [(18)F]-FDG PET/CT examinations were performed in 12 patients with LVV. MRI of the vessel wall by T1-weighted and T2-weighted sequences was used for anatomical localization of FDG uptake and identification of morphological changes associated with LVV. In addition, contrast-enhanced (CE) magnetic resonance angiography (MRA) was performed. The vascular FDG uptake in the vasculitis group was compared to a reference group of 16 patients using a four-point visual score. Visual scores and quantitative parameters [maximum standardized uptake value (SUVmax) and target to background ratio (TBR)] were compared between PET/MRI and PET/CT. Furthermore, correlations between C-reactive protein (CRP) and quantitative PET results, as well the extent of vasculitis in PET, MRI/CE-MRA and combined PET/MRI, were analysed.
RESULTS
TBRs, SUVmax values and visual scores correlated well between PET/MRI and PET/CT (r = 0.92, r = 0.91; r = 0.84, p < 0.05). There was no significant difference between both modalities concerning SUVmax measurements and visual scores. In PET/MRI, PET alone revealed abnormal FDG uptake in 86 vascular regions. MRI/CE-MRA indicated 49 vessel segments with morphological changes related to vasculitis, leading to a total number of 95 vasculitis regions in combination with PET. Strong and significant correlations between CRP and disease extent in PET alone (r = 0.75, p = 0.0067) and PET/MRI (r = 0.92, p < 0.0001) in contrast to MRI/CE-MRA only were observed. Regarding disease activity, no significant correlations were seen between quantitative PET results and CRP, although there was a trend towards significance (r = 0.55, p = 0.0651). PET/MRI also showed active LVV in 15/16 examinations.
CONCLUSION
Hybrid PET/MRI is feasible in LVV and holds promise for precisely determining disease extent and disease activity.
目的
本研究旨在通过比较[(18)F]氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/磁共振成像（MRI）与 PET/CT 的视觉和定量参数，评估在大血管血管炎（LVV）患者中使用混合 [(18)F]FDG PET/MRI 的可行性。此外，还评估了 PET/MRI 在 LVV 疾病活动和范围中的价值。
方法
对 12 例 LVV 患者共进行了 16 次 [(18)F]FDG PET/MRI 和 12 次 [(18)F]-FDG PET/CT 检查。采用 T1 加权和 T2 加权序列对血管壁进行 MRI 检查，用于 FDG 摄取的解剖定位和识别与 LVV 相关的形态学变化。此外，还进行了对比增强（CE）磁共振血管造影（MRA）。使用四点视觉评分将血管炎组的血管 FDG 摄取与 16 例患者的参考组进行比较。比较 PET/MRI 和 PET/CT 之间的视觉评分和定量参数[最大标准化摄取值（SUVmax）和靶标与背景比（TBR）]。此外，还分析了 C 反应蛋白（CRP）与定量 PET 结果之间的相关性，以及血管炎在 PET、MRI/CE-MRA 和联合 PET/MRI 中的程度。
结果
TBR、SUVmax 值和视觉评分在 PET/MRI 和 PET/CT 之间相关性良好（r=0.92，r=0.91；r=0.84，p<0.05）。两种方式在 SUVmax 测量和视觉评分方面均无显著差异。在 PET/MRI 中，PET 单独显示 86 个血管区域存在异常 FDG 摄取。MRI/CE-MRA 显示 49 个与血管炎相关的形态学改变的血管节段，与 PET 结合导致共 95 个血管炎区域。单独 PET（r=0.75，p=0.0067）和 PET/MRI（r=0.92，p<0.0001）中 CRP 与疾病程度之间存在强烈且显著的相关性，而 MRI/CE-MRA 仅显示出弱相关性。关于疾病活动，尽管有显著趋势（r=0.55，p=0.0651），但定量 PET 结果与 CRP 之间未见显著相关性。PET/MRI 还显示 16 次检查中有 15 次存在活动性 LVV。
结论
混合 [(18)F]FDG PET/MRI 可用于 LVV，有望精确确定疾病范围和疾病活动度。
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