FDG Uptake by Prosthetic Arterial Grafts in Large Vessel Vasculitis Is Not Specific for Active Disease
This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV). The role of 18F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([18F]FDG-PET/CT) in the management of LVV remains t...
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| Published in | JACC. Cardiovascular imaging Vol. 10; no. 9; pp. 1042 - 1052 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.09.2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1936-878X 1876-7591 1876-7591 |
| DOI | 10.1016/j.jcmg.2016.09.027 |
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| Abstract | This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV).
The role of 18F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([18F]FDG-PET/CT) in the management of LVV remains to be defined. Although [18F]FDG uptake at arterial graft sites raises concerns regarding active arteritis or infection, its clinical significance in LVV has never been formally studied.
An observational prospective study sought to identify patients with Takayasu arteritis (TA) undergoing [18F]FDG-PET/CT more than 6 months after graft surgery from a large cohort of patients from 2 tertiary referral centers. [18F]FDG uptake by the graft and native arteries was scored on a scale of 0 to 3 relative to hepatic uptake, and periprosthetic maximum standardized uptake value (SUVmax) was calculated. Periprosthetic [18F]FDG uptake in active disease was compared with that in inactive disease, and arterial progression was assessed by prospective magnetic resonance angiography (MRA).
Twenty-six subjects with TA were enrolled. All were afebrile with negative blood culture. Periprosthetic uptake was significant in 23 of 26 patients, and the mean SUVmax was 4.21 ± 1.46. Median periprosthetic [18F]FDG uptake score (3; interquartile range [IQR]: 3 to 3) was higher than in native aorta (1; IQR: 0 to 1; p < 0.001). Graft-specific [18F]FDG uptake was unrelated to disease activity. Despite the high frequency of graft-associated [18F]FDG uptake, sequential MRAs did not reveal arterial progression in 25 of 26 patients; the 1 remaining case showed minor progression limited to native arteries. Nine patients underwent repeated PET/CT scanning without showing changes in graft-specific uptake, despite increased treatment.
Significant [18F]FDG uptake that is confined to arterial graft sites in patients with LVV does not reflect clinically relevant disease activity or progression. To minimize exposure to immunosuppression and in the face of negative blood culture, clinically quiescent arteritis, normal or stably raised C-reactive protein levels, we elected not to escalate treatment and monitor progression with MRA.
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| AbstractList | This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV).
The role of 18F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([18F]FDG-PET/CT) in the management of LVV remains to be defined. Although [18F]FDG uptake at arterial graft sites raises concerns regarding active arteritis or infection, its clinical significance in LVV has never been formally studied.
An observational prospective study sought to identify patients with Takayasu arteritis (TA) undergoing [18F]FDG-PET/CT more than 6 months after graft surgery from a large cohort of patients from 2 tertiary referral centers. [18F]FDG uptake by the graft and native arteries was scored on a scale of 0 to 3 relative to hepatic uptake, and periprosthetic maximum standardized uptake value (SUVmax) was calculated. Periprosthetic [18F]FDG uptake in active disease was compared with that in inactive disease, and arterial progression was assessed by prospective magnetic resonance angiography (MRA).
Twenty-six subjects with TA were enrolled. All were afebrile with negative blood culture. Periprosthetic uptake was significant in 23 of 26 patients, and the mean SUVmax was 4.21 ± 1.46. Median periprosthetic [18F]FDG uptake score (3; interquartile range [IQR]: 3 to 3) was higher than in native aorta (1; IQR: 0 to 1; p < 0.001). Graft-specific [18F]FDG uptake was unrelated to disease activity. Despite the high frequency of graft-associated [18F]FDG uptake, sequential MRAs did not reveal arterial progression in 25 of 26 patients; the 1 remaining case showed minor progression limited to native arteries. Nine patients underwent repeated PET/CT scanning without showing changes in graft-specific uptake, despite increased treatment.
Significant [18F]FDG uptake that is confined to arterial graft sites in patients with LVV does not reflect clinically relevant disease activity or progression. To minimize exposure to immunosuppression and in the face of negative blood culture, clinically quiescent arteritis, normal or stably raised C-reactive protein levels, we elected not to escalate treatment and monitor progression with MRA.
[Display omitted] This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV). The role of F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([ F]FDG-PET/CT) in the management of LVV remains to be defined. Although [ F]FDG uptake at arterial graft sites raises concerns regarding active arteritis or infection, its clinical significance in LVV has never been formally studied. An observational prospective study sought to identify patients with Takayasu arteritis (TA) undergoing [ F]FDG-PET/CT more than 6 months after graft surgery from a large cohort of patients from 2 tertiary referral centers. [ F]FDG uptake by the graft and native arteries was scored on a scale of 0 to 3 relative to hepatic uptake, and periprosthetic maximum standardized uptake value (SUV ) was calculated. Periprosthetic [ F]FDG uptake in active disease was compared with that in inactive disease, and arterial progression was assessed by prospective magnetic resonance angiography (MRA). Twenty-six subjects with TA were enrolled. All were afebrile with negative blood culture. Periprosthetic uptake was significant in 23 of 26 patients, and the mean SUV was 4.21 ± 1.46. Median periprosthetic [ F]FDG uptake score (3; interquartile range [IQR]: 3 to 3) was higher than in native aorta (1; IQR: 0 to 1; p < 0.001). Graft-specific [ F]FDG uptake was unrelated to disease activity. Despite the high frequency of graft-associated [ F]FDG uptake, sequential MRAs did not reveal arterial progression in 25 of 26 patients; the 1 remaining case showed minor progression limited to native arteries. Nine patients underwent repeated PET/CT scanning without showing changes in graft-specific uptake, despite increased treatment. Significant [ F]FDG uptake that is confined to arterial graft sites in patients with LVV does not reflect clinically relevant disease activity or progression. To minimize exposure to immunosuppression and in the face of negative blood culture, clinically quiescent arteritis, normal or stably raised C-reactive protein levels, we elected not to escalate treatment and monitor progression with MRA. Abstract Objectives This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV). Background The role of18 F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([18 F]FDG-PET/CT) in the management of LVV remains to be defined. Although [18 F]FDG uptake at arterial graft sites raises concerns regarding active arteritis or infection, its clinical significance in LVV has never been formally studied. Methods An observational prospective study sought to identify patients with Takayasu arteritis (TA) undergoing [18 F]FDG-PET/CT more than 6 months after graft surgery from a large cohort of patients from 2 tertiary referral centers. [18 F]FDG uptake by the graft and native arteries was scored on a scale of 0 to 3 relative to hepatic uptake, and periprosthetic maximum standardized uptake value (SUVmax ) was calculated. Periprosthetic [18 F]FDG uptake in active disease was compared with that in inactive disease, and arterial progression was assessed by prospective magnetic resonance angiography (MRA). Results Twenty-six subjects with TA were enrolled. All were afebrile with negative blood culture. Periprosthetic uptake was significant in 23 of 26 patients, and the mean SUVmax was 4.21 ± 1.46. Median periprosthetic [18 F]FDG uptake score (3; interquartile range [IQR]: 3 to 3) was higher than in native aorta (1; IQR: 0 to 1; p < 0.001). Graft-specific [18 F]FDG uptake was unrelated to disease activity. Despite the high frequency of graft-associated [18 F]FDG uptake, sequential MRAs did not reveal arterial progression in 25 of 26 patients; the 1 remaining case showed minor progression limited to native arteries. Nine patients underwent repeated PET/CT scanning without showing changes in graft-specific uptake, despite increased treatment. Conclusions Significant [18 F]FDG uptake that is confined to arterial graft sites in patients with LVV does not reflect clinically relevant disease activity or progression. To minimize exposure to immunosuppression and in the face of negative blood culture, clinically quiescent arteritis, normal or stably raised C-reactive protein levels, we elected not to escalate treatment and monitor progression with MRA. This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV).OBJECTIVESThis study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV).The role of 18F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([18F]FDG-PET/CT) in the management of LVV remains to be defined. Although [18F]FDG uptake at arterial graft sites raises concerns regarding active arteritis or infection, its clinical significance in LVV has never been formally studied.BACKGROUNDThe role of 18F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([18F]FDG-PET/CT) in the management of LVV remains to be defined. Although [18F]FDG uptake at arterial graft sites raises concerns regarding active arteritis or infection, its clinical significance in LVV has never been formally studied.An observational prospective study sought to identify patients with Takayasu arteritis (TA) undergoing [18F]FDG-PET/CT more than 6 months after graft surgery from a large cohort of patients from 2 tertiary referral centers. [18F]FDG uptake by the graft and native arteries was scored on a scale of 0 to 3 relative to hepatic uptake, and periprosthetic maximum standardized uptake value (SUVmax) was calculated. Periprosthetic [18F]FDG uptake in active disease was compared with that in inactive disease, and arterial progression was assessed by prospective magnetic resonance angiography (MRA).METHODSAn observational prospective study sought to identify patients with Takayasu arteritis (TA) undergoing [18F]FDG-PET/CT more than 6 months after graft surgery from a large cohort of patients from 2 tertiary referral centers. [18F]FDG uptake by the graft and native arteries was scored on a scale of 0 to 3 relative to hepatic uptake, and periprosthetic maximum standardized uptake value (SUVmax) was calculated. Periprosthetic [18F]FDG uptake in active disease was compared with that in inactive disease, and arterial progression was assessed by prospective magnetic resonance angiography (MRA).Twenty-six subjects with TA were enrolled. All were afebrile with negative blood culture. Periprosthetic uptake was significant in 23 of 26 patients, and the mean SUVmax was 4.21 ± 1.46. Median periprosthetic [18F]FDG uptake score (3; interquartile range [IQR]: 3 to 3) was higher than in native aorta (1; IQR: 0 to 1; p < 0.001). Graft-specific [18F]FDG uptake was unrelated to disease activity. Despite the high frequency of graft-associated [18F]FDG uptake, sequential MRAs did not reveal arterial progression in 25 of 26 patients; the 1 remaining case showed minor progression limited to native arteries. Nine patients underwent repeated PET/CT scanning without showing changes in graft-specific uptake, despite increased treatment.RESULTSTwenty-six subjects with TA were enrolled. All were afebrile with negative blood culture. Periprosthetic uptake was significant in 23 of 26 patients, and the mean SUVmax was 4.21 ± 1.46. Median periprosthetic [18F]FDG uptake score (3; interquartile range [IQR]: 3 to 3) was higher than in native aorta (1; IQR: 0 to 1; p < 0.001). Graft-specific [18F]FDG uptake was unrelated to disease activity. Despite the high frequency of graft-associated [18F]FDG uptake, sequential MRAs did not reveal arterial progression in 25 of 26 patients; the 1 remaining case showed minor progression limited to native arteries. Nine patients underwent repeated PET/CT scanning without showing changes in graft-specific uptake, despite increased treatment.Significant [18F]FDG uptake that is confined to arterial graft sites in patients with LVV does not reflect clinically relevant disease activity or progression. To minimize exposure to immunosuppression and in the face of negative blood culture, clinically quiescent arteritis, normal or stably raised C-reactive protein levels, we elected not to escalate treatment and monitor progression with MRA.CONCLUSIONSSignificant [18F]FDG uptake that is confined to arterial graft sites in patients with LVV does not reflect clinically relevant disease activity or progression. To minimize exposure to immunosuppression and in the face of negative blood culture, clinically quiescent arteritis, normal or stably raised C-reactive protein levels, we elected not to escalate treatment and monitor progression with MRA. |
| Author | Mukherjee, Jaita Salerno, Annalaura Manfredi, Angelo A. Sartorelli, Silvia Baldissera, Elena Nash, Julian Papa, Maurizio Incerti, Elena Andrews, Jacqueline Tombetti, Enrico Al-Nahhas, Adil De Cobelli, Francesco Ramirez, Giuseppe A. Fallanca, Federico Mason, Justin C. Barwick, Tara D. Sabbadini, Maria Grazia Gianolli, Luigi Youngstein, Taryn Humphreys, Emyr Tombolini, Elisabetta Picchio, Maria |
| Author_xml | – sequence: 1 givenname: Taryn surname: Youngstein fullname: Youngstein, Taryn organization: Cardiovascular Sciences and Rheumatology Units, Imperial College Healthcare National Health Service Trust, London, United Kingdom – sequence: 2 givenname: Enrico surname: Tombetti fullname: Tombetti, Enrico organization: Cardiovascular Sciences and Rheumatology Units, Imperial College Healthcare National Health Service Trust, London, United Kingdom – sequence: 3 givenname: Jaita surname: Mukherjee fullname: Mukherjee, Jaita organization: Cardiovascular Sciences and Rheumatology Units, Imperial College Healthcare National Health Service Trust, London, United Kingdom – sequence: 4 givenname: Tara D. surname: Barwick fullname: Barwick, Tara D. organization: Imaging Department, Imperial College Healthcare National Health Service Trust, London, United Kingdom – sequence: 5 givenname: Adil surname: Al-Nahhas fullname: Al-Nahhas, Adil organization: Imaging Department, Imperial College Healthcare National Health Service Trust, London, United Kingdom – sequence: 6 givenname: Emyr surname: Humphreys fullname: Humphreys, Emyr organization: Prince Charles Hospital, Merthyr Tydfil, Wales – sequence: 7 givenname: Julian surname: Nash fullname: Nash, Julian organization: Rheumatology Unit, University Hospital Wales, Cardiff, Wales – sequence: 8 givenname: Jacqueline surname: Andrews fullname: Andrews, Jacqueline organization: Rheumatology Unit, Chapel Allerton Hospital, Leeds, United Kingdom – sequence: 9 givenname: Elena surname: Incerti fullname: Incerti, Elena organization: Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 10 givenname: Elisabetta surname: Tombolini fullname: Tombolini, Elisabetta organization: Unit of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 11 givenname: Annalaura surname: Salerno fullname: Salerno, Annalaura organization: Vita-Salute San Raffaele University, Milan, Italy – sequence: 12 givenname: Silvia surname: Sartorelli fullname: Sartorelli, Silvia organization: Unit of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 13 givenname: Giuseppe A. surname: Ramirez fullname: Ramirez, Giuseppe A. organization: Unit of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 14 givenname: Maurizio surname: Papa fullname: Papa, Maurizio organization: Unit of Radiology-Ville Turro, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 15 givenname: Maria Grazia surname: Sabbadini fullname: Sabbadini, Maria Grazia organization: Unit of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 16 givenname: Luigi surname: Gianolli fullname: Gianolli, Luigi organization: Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 17 givenname: Francesco surname: De Cobelli fullname: De Cobelli, Francesco organization: Vita-Salute San Raffaele University, Milan, Italy – sequence: 18 givenname: Federico surname: Fallanca fullname: Fallanca, Federico organization: Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 19 givenname: Elena surname: Baldissera fullname: Baldissera, Elena organization: Unit of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 20 givenname: Angelo A. surname: Manfredi fullname: Manfredi, Angelo A. organization: Unit of Internal Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 21 givenname: Maria surname: Picchio fullname: Picchio, Maria organization: Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy – sequence: 22 givenname: Justin C. surname: Mason fullname: Mason, Justin C. email: justin.mason@imperial.ac.uk organization: Cardiovascular Sciences and Rheumatology Units, Imperial College Healthcare National Health Service Trust, London, United Kingdom |
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| Keywords | CRP GCA SUV MR angiography [18F]FDG-PET/CT arterial graft large-vessel vasculitis Takayasu arteritis positron emission tomography LVV MRA TA C-reactive protein 18F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography standardized uptake value giant-cell arteritis [ 18F]FDG-PET/CT magnetic resonance angiography |
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| Snippet | This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV).
The... Abstract Objectives This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel... This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis... |
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| SubjectTerms | Adolescent Adult arterial graft Arteries - diagnostic imaging Arteries - surgery Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Cardiovascular Cross-Sectional Studies Female Fluorodeoxyglucose F18 - administration & dosage Humans Italy large-vessel vasculitis London Magnetic Resonance Angiography Male Middle Aged MR angiography positron emission tomography Positron Emission Tomography Computed Tomography Predictive Value of Tests Prospective Studies Radiopharmaceuticals - administration & dosage Takayasu arteritis Tertiary Care Centers Time Factors Treatment Outcome Vasculitis - diagnostic imaging Vasculitis - etiology Young Adult |
| Title | FDG Uptake by Prosthetic Arterial Grafts in Large Vessel Vasculitis Is Not Specific for Active Disease |
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