[¹⁸F]FDG-PET bei Großgefäß-Vaskulitiden

Zusammenfassung

Die [¹⁸F]FDG-PET ist ein nicht-invasives bildgebendes Verfahren, das entzündliche Veränderungen im Rahmen einer Riesenzell- oder Takayasu-Arteriitis darstellen kann. Die [¹⁸F]FDG-PET ist effizient in der Bewertung der Aktivität und des Ausmaßes beider Erkrankungen und ist der Magnetresonanztomografie in der Darstellung des Ganzkörper-Gefäßstatus überlegen. Eine visuelle Gradeinteilung der vaskulären [¹⁸F]FDG-Aufnahme hilft bei der Abgrenzung der Arteriitis von der Atherosklerose und führt dadurch zu einer hohen Spezifität. Eine hohe Sensitivität wird durch eine Durchführung der Untersuchung während der aktiven Entzündungsphase erreicht. Die [¹⁸F]FDG-PET hat das Potenzial, sich zu einer wertvollen und primär einsetzbaren Methode in der diagnostischen Abklärung sowohl der Riesenzellarteriitis als auch der Takayasu-Arteriitis zu entwickeln. Notwendig hierzu sind jedoch der Konsens zum Untersuchungsprotokoll sowie weitere klinische Studien. Ziel dieses Artikels ist, einen Überblick über die aktuelle Datenlage zu verschaffen und Nuklearmedizinern bei der Indikation, Durchführung und Beurteilung der [¹⁸F]FDG-PET bei Großgefäß-Vaskulitiden zu unterstützen.

Abstract

[¹⁸F]FDG-PET is a non-invasive metabolic imaging modality based on the regional distribution of fluorine-18-fluorodeoxyglucose that is highly effective in assessing the activity and the extent of giant cell arteritis and Takayasu's arteritis. It has shown to identify more affected vascular regions than morphologic imaging with Magnetic Resonance Imaging in both diseases. A visual grading of vascular [¹⁸F]FDG-uptake helps to discriminate arteritis from atherosclerosis und therefore provides high specificity. High sensitivity is reached by scanning during the active inflammatory phase. [¹⁸F]FDG-PET has the potential to develop into a valuable tool in the diagnostic work-up of giant cell arteritis and Takayasu's arteritis, respectively, and might become a first-line investigation technique. Therefore consensus regarding the most favorable imaging procedure as well as further clinical evidence is needed. The purpose of this review is to summarize current information on the present clinical data and to assist nuclear medicine practitioners in recommending, performing and interpreting the results of [¹⁸F]FDG-PET in patients with suspected large vessel vasculitis.

Schlüsselwörter

Vaskulitis der großen Gefäße - Riesenzellarteriitis - Takayasu-Arteriitis - FDG - PET

Key words

large vessel vasculitis - giant cell arteritis - Takayasu aortitis - FDG - PET

Literatur

• 1 Been L B, Suurmeijer A J, Cobben D C, Jager P L, Hoekstra H J, Elsinga P H. [¹⁸F]FLT-PET in oncology: current status and opportunities.  Eur J Nucl Med Mol Imaging. 2004;  31 1659-1672
• 2 Turlakow A, Yeung H W, Pui J, Macapinlac H, Liebovitz E, Rusch V, Goy A, Larson S M. Fludeoxyglucose positron emission tomography in the diagnosis of giant cell arteritis.  Arch Intern Med. 2001;  161 1003-1007
• 3 Blockmans D, Van Moer E, Dehem J, Feys C, Mortelmans L. Positron emission tomography can reveal abdominal periaortitis.  Clin Nucl Med. 2002;  27 211-212
• 4 Wenger M, Gasser R, Donnemiller E, Erler H, Glossmann H, Patsch J R, Moncayo R, Schirmer M. Images in cardiovascular medicine. Generalized large vessel arteritis visualized by ¹⁸fluorodeoxyglucose-positron emission tomography.  Circulation. 2003;  107 923
• 5 Brodmann M, Lipp R W, Aigner R, Pilger E. Positron emission tomography reveals extended thoracic and abdominal peri-aortitis.  Vasc Med. 2003;  8 127-128
• 6 Wiest R, Gluck T, Schonberger J, Scholmerich J, Eilles C, Muller-Ladner U. Clinical image: occult large vessel vasculitis diagnosed by PET imaging.  Rheumatol Int. 2001;  20 250
• 7 De Winter F, Petrovic M, Van de Wiele C, Vogelaers D, Afschrift M, Dierckx R A. Imaging of giant cell arteritis: evidence of splenic involvement using FDG positron emission tomography.  Clin Nucl Med. 2000;  25 633-634
• 8 Hara M, Goodman P C, Leder R A. FDG-PET finding in early-phase Takayasu arteritis.  J Comput Assist Tomogr. 1999;  23 16-18
• 9 Malik I S, Harare O, A A L-N, Beatt K, Mason J. Takayasu's arteritis: management of left main stem stenosis.  Heart. 2003;  89 e9
• 10 Walter M A, Melzer R A, Graf M, Tyndall A, Muller-Brand J, Nitzsche E U. [¹⁸F]FDG-PET of giant-cell aortitis.  Rheumatology (Oxford). 2005;  44 690-691
• 11 Hutchinson J. On a peculiar form of thrombotic arteritis of the aged which is sometimes productive or gangrene.  Arch Surg. 1890;  1 323-329
• 12 Klein R G, Hunder G G, Stanson A W, Sheps S G. Large artery involvement in giant cell (temporal) arteritis.  Ann Intern Med. 1975;  83 806-812
• 13 Salvarani C, Gabriel S E, O'Fallon W M, Hunder G G. The incidence of giant cell arteritis in Olmsted County, Minnesota: apparent fluctuations in a cyclic pattern.  Ann Intern Med. 1995;  123 192-194
• 14 Franzen P, Sutinen S, Knorring J von. Giant cell arteritis and polymyalgia rheumatica in a region of Finland: an epidemiologic, clinical and pathologic study, 1984-1988.  J Rheumatol. 1992;  19 273-276
• 15 Gonzalez-Gay M A, Alonso M D, Aguero J J, Bal M, Fernandez-Camblor B, Sanchez-Andrade A. Giant cell arteritis in Mediterranean countries: comment on the article by Salvarani et al.  Arthritis Rheum. 1992;  35 1249-1250
• 16 Ostberg G. An arteritis with special reference to polymyalgia arteritica.  Acta Pathol Microbiol Scand [A]. 1973;  237 Suppl 237 1-59
• 17 Lie J T. Illustrated histopathologic classification criteria for selected vasculitis syndromes. American College of Rheumatology Subcommittee on Classification of Vasculitis.  Arthritis Rheum. 1990;  33 1074-1087
• 18 Weyand C M. The Dunlop-Dottridge Lecture: The pathogenesis of giant cell arteritis.  J Rheumatol. 2000;  27 517-522
• 19 Salvarani C, Macchioni P L, Tartoni P L, Rossi F, Baricchi R, Castri C, Chiaravalloti F, Portioli I. Polymyalgia rheumatica and giant cell arteritis: a 5-year epidemiologic and clinical study in Reggio Emilia, Italy.  Clin Exp Rheumatol. 1987;  5 205-215
• 20 Huston K A, Hunder G G. Giant cell (cranial) arteritis: a clinical review.  Am Heart J. 1980;  100 99-105
• 21 Calamia K T, Hunder G G. Giant cell arteritis (temporal arteritis) presenting as fever of undetermined origin.  Arthritis Rheum. 1981;  24 1414-1418
• 22 Takayasu M. Case with unusual changes of the central vessels in the retina.  Acta Soc Ophthal Jpn. 1908;  12 554-555
• 23 Waern A U, Andersson P, Hemmingsson A. Takayasu's arteritis: a hospital-region based study on occurrence, treatment and prognosis.  Angiology. 1983;  34 311-320
• 24 Hall S, Barr W, Lie J T, Stanson A W, Kazmier F J, Hunder G G. Takayasu arteritis. A study of 32 North American patients.  Medicine (Baltimore). 1985;  64 89-99
• 25 el-Reshaid K, Varro J, al-Duwairi Q, Anim J T. Takayasu's arteritis in Kuwait.  J Trop Med Hyg. 1995;  98 299-305
• 26 Lande A. Abdominal Takayasu's aortitis, the middle aortic syndrome and atherosclerosis. A critical review.  Int Angiol. 1998;  17 1-9
• 27 Nasu T. Pathology of pulseless disease. A systematic study and critical review of twenty-one autopsy cases reported in Japan.  Angiology. 1963;  14 225-242
• 28 Matsunaga N, Hayashi K, Sakamoto I, Ogawa Y, Matsumoto T. Takayasu arteritis: protean radiologic manifestations and diagnosis.  Radiographics. 1997;  17 579-594
• 29 Moriwaki R, Noda M, Yajima M, Sharma B K, Numano F. Clinical manifestations of Takayasu arteritis in India and Japan - new classification of angiographic findings.  Angiology. 1997;  48 369-379
• 30 Hunder G G, Bloch D A, Michel B A, Stevens M B, Arend W P, Calabrese L H, Edworthy S M, Fauci A S, Leavitt R Y, Lie J T. et al . The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis.  Arthritis Rheum. 1990;  33 1122-1128
• 31 Arend W P, Michel B A, Bloch D A, Hunder G G, Calabrese L H, Edworthy S M, Fauci A S, Leavitt R Y, Lie J T, Lightfoot Jr R W. et al . The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis.  Arthritis Rheum. 1990;  33 1129-1134
• 32 Rao J K, Allen N B, Pincus T. Limitations of the 1990 American College of Rheumatology classification criteria in the diagnosis of vasculitis.  Ann Intern Med. 1998;  129 345-352
• 33 Salvarani C, Hunder G G. Giant cell arteritis with low erythrocyte sedimentation rate: frequency of occurence in a population-based study.  Arthritis Rheum. 2001;  45 140-145
• 34 Hayreh S S, Zimmerman B. Management of giant cell arteritis. Our 27-year clinical study: new light on old controversies.  Ophthalmologica. 2003;  217 239-259
• 35 Gonzalez-Gay M A, Garcia-Porrua C, Salvarani C, Olivieri I, Hunder G G. The spectrum of conditions mimicking polymyalgia rheumatica in Northwestern Spain.  J Rheumatol. 2000;  27 2179-2184
• 36 Lambert M, Hachulla E, Hatron P Y, Perez-Cousin M, Beregi J P, Warembourg H, Devulder B. [Takayasu's arteritis: vascular investigations and therapeutic management. Experience with 16 patients].  Rev Med Interne. 1998;  19 878-884
• 37 Lambert M, Hatron P Y, Hachulla E, Warembourg H, Devulder B. Takayasu's arteritis diagnosed at the early systemic phase: diagnosis with noninvasive investigation despite normal findings on angiography.  J Rheumatol. 1998;  25 376-377
• 38 Ishimori T, Saga T, Mamede M, Kobayashi H, Higashi T, Nakamoto Y, Sato N, Konishi J. Increased ⁽¹⁸⁾F-FDG uptake in a model of inflammation: concanavalin A-mediated lymphocyte activation.  J Nucl Med. 2002;  43 658-663
• 39 Jones H A, Cadwallader K A, White J F, Uddin M, Peters A M, Chilvers E R. Dissociation between respiratory burst activity and deoxyglucose uptake in human neutrophil granulocytes: implications for interpretation of ⁽¹⁸⁾F-FDG PET images.  J Nucl Med. 2002;  43 652-657
• 40 Schelbert H R, Hoh C K, Royal H D, Brown M, Dahlbom M N, Dehdashti F, Wahl R L. Procedure guideline for tumor imaging using fluorine-18-FDG. Society of Nuclear Medicine.  J Nucl Med. 1998;  39 1302-1305
• 41 Bombardieri E, Aktolun C, Baum R P, Bishof-Delaloye A, Buscombe J, Chatal J F, Maffioli L, Moncayo R, Mortelmans L, Reske S N. FDG-PET: procedure guidelines for tumour imaging.  Eur J Nucl Med Mol Imaging. 2003;  30 BP115-BP124
• 42 Andrews J, Al-Nahhas A, Pennell D J, Hossain M S, Davies K A, Haskard D O, Mason J C. Non-invasive imaging in the diagnosis and management of Takayasu's arteritis.  Ann Rheum Dis. 2004;  63 995-1000
• 43 Webb M, Chambers A, A A L-N, Mason J C, Maudlin L, Rahman L, Frank J. The role of ¹⁸F-FDG PET in characterising disease activity in Takayasu arteritis.  Eur J Nucl Med Mol Imaging. 2004;  31 627-634
• 44 Bleeker-Rovers C P, Bredie S J, van der Meer J W, Corstens F H, Oyen W J. F-18-fluorodeoxyglucose positron emission tomography in diagnosis and follow-up of patients with different types of vasculitis.  Neth J Med. 2003;  61 323-329
• 45 Brodmann M, Lipp R W, Passath A, Seinost G, Pabst E, Pilger E. The role of 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries.  Rheumatology (Oxford). 2004;  43 241-242
• 46 Moosig F, Czech N, Mehl C, Henze E, Zeuner R A, Kneba M, Schroder J O. Correlation between 18-fluorodeoxyglucose accumulation in large vessels and serological markers of inflammation in polymyalgia rheumatica: a quantitative PET study.  Ann Rheum Dis. 2004;  63 870-873
• 47 Meller J, Strutz F, Siefker U, Scheel A, Sahlmann C O, Lehmann K, Conrad M, Vosshenrich R. Early diagnosis and follow-up of aortitis with [⁽¹⁸⁾F]FDG PET and MRI.  Eur J Nucl Med Mol Imaging. 2003;  30 730-736
• 48 Walter M A, Melzer R A, Schindler C, Muller-Brand J, Tyndall A, Nitzsche E U. The value of [¹⁸F]FDG-PET in the diagnosis of large-vessel vasculitis and the assessment of activity and extent of disease.  Eur J Nucl Med Mol Imaging. 2005;  32 674-681
• 49 Kobayashi Y, Ishii K, Oda K, Nariai T, Tanaka Y, Ishiwata K, Numano F. Aortic wall inflammation due to Takayasu arteritis imaged with ¹⁸F-FDG PET coregistered with enhanced CT.  J Nucl Med. 2005;  46 917-922
• 50 Blockmans D, Stroobants S, Maes A, Mortelmans L. Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch.  Am J Med. 2000;  108 246-249
• 51 Meller J, Grabbe E, Becker W, Vosshenrich R. Value of F-18 FDG hybrid camera PET and MRI in early takayasu aortitis.  Eur Radiol. 2003;  13 400-405
• 52 Scheel A K, Meller J, Vosshenrich R, Kohlhoff E, Siefker U, Muller G A, Strutz F. Diagnosis and follow up of aortitis in the elderly.  Ann Rheum Dis. 2004;  63 1507-1510
• 53 Kroger K, Antoch G, Goyen M, Freudenberg L S, Veit P, Janicke I, Bockisch A, Forsting M. Positron emission tomography/computed tomography improves diagnostics of inflammatory arteritis.  Heart Vessels. 2005;  20 179-183
• 54 Antoch G, Freudenberg L S, Debatin J F, Kroger K. Images in vascular medicine. Diagnosis of giant cell arteritis with PET/CT.  Vasc Med. 2003;  8 281-282
• 55 Rudd J H, Warburton E A, Fryer T D, Jones H A, Clark J C, Antoun N, Johnstrom P, Davenport A P, Kirkpatrick P J, Arch B N. et al . Imaging atherosclerotic plaque inflammation with [¹⁸F]-fluorodeoxyglucose positron emission tomography.  Circulation. 2002;  105 2708-2711
• 56 Yun M, Yeh D, Araujo L I, Jang S, Newberg A, Alavi A. F-18 FDG uptake in the large arteries: a new observation.  Clin Nucl Med. 2001;  26 314-319
• 57 Yun M, Jang S, Cucchiara A, Newberg A B, Alavi A. ¹⁸F FDG uptake in the large arteries: a correlation study with the atherogenic risk factors.  Semin Nucl Med. 2002;  32 70-76
• 58 Kerr G S, Hallahan C W, Giordano J, Leavitt R Y, Fauci A S, Rottem M, Hoffman G S. Takayasu arteritis.  Ann Intern Med. 1994;  120 919-929
• 59 Sachelarie I, Kerr K, Ghesani M, Blum R H. Integrated PET-CT: evidence-based review of oncology indications.  Oncology (Williston Park). 2005;  19 481-490 ,  discussion 490-492, 495-496
• 60 Macapinlac H A. FDG PET and PET/CT imaging in lymphoma and melanoma.  Cancer J. 2004;  10 262-270
• 61 Frank S J, Chao K S, Schwartz D L, Weber R S, Apisarnthanarax S, Macapinlac H A. Technology insight: PET and PET/CT in head and neck tumor staging and radiation therapy planning.  Nat Clin Pract Oncol. 2005;  2 526-533
• 62 Blockmans D, Maes A, Stroobants S, Nuyts J, Bormans G, Knockaert D, Bobbaers H, Mortelmans L. New arguments for a vasculitic nature of polymyalgia rheumatica using positron emission tomography.  Rheumatology (Oxford). 1999;  38 444-447
• 63 Blockmans D, Baeyens H, Van Loon R, Lauwers G, Bobbaers H. Periaortitis and aortic dissection due to Wegener's granulomatosis.  Clin Rheumatol. 2000;  19 161-164
• 64 Belhocine T, Kaye O, Delanaye P, Corman V, Baghaie M, Deprez M, Daenen F, De Barsy C, Beckers C, Gomez P. et al . [Horton's disease and extra-temporal vessel locations: role of ¹⁸FDG PET scan. Report of 3 cases and review of the literature].  Rev Med Interne. 2002;  23 584-591
• 65 Blockmans D, de Ceuninck L, Vanderschueren S, Knockaert D, Mortelmans L, Bobbaers H. [Repetitive ¹⁸F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients].  Arthritis Rheum. 2006;  55 131-137