Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland.
Clinical Center, Radiology and Imaging Sciences, NIH, Bethesda, Maryland.
Arthritis Rheumatol. 2023 Jan;75(1):98-107. doi: 10.1002/art.42290. Epub 2022 Dec 8.
To assess whether vascular activity seen on F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scan is associated with angiographic change in large vessel vasculitis (LVV).
Patients with LVV were recruited into a prospective cohort. All patients underwent magnetic resonance angiography or computed tomography angiography and FDG-PET imaging. Follow-up imaging using the same imaging modalities was obtained ≥6 months later per a standardized imaging protocol. Arterial damage, defined as stenosis, occlusion, or aneurysm, and corresponding FDG uptake were evaluated in 17 arterial territories. On follow-up, development of new lesions was recorded, and existing lesions were characterized as improved, worsened, or unchanged.
A total of 1,091 arterial territories from 70 patients with LVV (38 patients with Takayasu arteritis, 32 patients with giant cell arteritis) were evaluated. Over a median 1.6 years of follow-up, new lesions developed only in 8 arterial territories in 5 patients with Takayasu arteritis. Arterial lesions improved in 16 territories and worsened in 6 territories. Most arterial territories that did not have vascular activity on FDG-PET scan at baseline had no angiographic change over the follow-up period (787 [99%] of 793). Few territories with baseline FDG-PET activity had angiographic change over time (24 [8%] of 298), but of the territories that developed angiographic change, 80% had FDG-PET activity at baseline. Within the same patient, an arterial territory with baseline FDG-PET activity had significantly increased risk for angiographic change compared to a paired arterial territory without FDG-PET activity (odds ratio 19.49 [95% confidence interval 2.44-156.02]; P < 0.01). Concomitant edema and wall thickening further increased risk for angiographic change.
Development of angiographic change was infrequent in this cohort of patients with LVV. A lack of baseline FDG-PET activity was strongly associated with stable angiographic disease. In cases of angiographic progression, change was preceded by the presence of FDG-PET activity.
评估 F-氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）上观察到的血管活性是否与大血管血管炎（LVV）的血管造影变化相关。
将 LVV 患者纳入前瞻性队列研究。所有患者均接受磁共振血管造影或计算机断层血管造影和 FDG-PET 成像。根据标准化成像方案，在≥6 个月后获得相同成像方式的随访成像。评估 17 个动脉区域的动脉损伤，定义为狭窄、闭塞或动脉瘤，以及相应的 FDG 摄取。在随访时，记录新病变的发生，并对现有病变进行改善、恶化或无变化的特征描述。
共评估了 70 例 LVV 患者的 1091 个动脉区域（38 例 Takayasu 动脉炎，32 例巨细胞动脉炎）。在中位数为 1.6 年的随访期间，仅在 5 例 Takayasu 动脉炎患者的 8 个动脉区域中出现新病变。16 个动脉区域的病变改善，6 个动脉区域的病变恶化。大多数在基线时 FDG-PET 扫描无血管活性的动脉区域在随访期间没有血管造影变化（793 个中的 787 个[99%]）。随时间推移，少数基线 FDG-PET 活性的区域出现血管造影变化（298 个中的 24 个[8%]），但出现血管造影变化的区域中，80%在基线时有 FDG-PET 活性。在同一患者中，与没有 FDG-PET 活性的配对动脉区域相比，基线 FDG-PET 活性的动脉区域发生血管造影变化的风险显著增加（优势比 19.49[95%置信区间 2.44-156.02]；P<0.01）。同时存在水肿和壁增厚进一步增加了血管造影变化的风险。
在本 LVV 患者队列中，血管造影变化的发展并不常见。基线时缺乏 FDG-PET 活性与稳定的血管造影疾病密切相关。在血管造影进展的情况下，FDG-PET 活性的出现先于血管造影变化。
