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FDG uptake by prosthetic arterial grafts in large vessel vasculitis Is not specific for active disease

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Title: FDG uptake by prosthetic arterial grafts in large vessel vasculitis Is not specific for active disease
Authors: Youngstein, T
Tombetti, E
Mukherjee, J
Barwick, TD
Al-Nahhas, A
Humphreys, E
Nash, J
Andrews, J
Incerti, E
Tombolini, E
Salerno, A
Sartorelli, S
Ramirez, GA
Papa, M
Sabbadini, MG
Gianolli, L
De Cobelli, F
Fallanca, F
Baldissera, E
Manfredi, AA
Picchio, M
Mason, JC
Item Type: Journal Article
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 of (18)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.
Issue Date: 18-Jan-2017
Date of Acceptance: 15-Sep-2016
URI: http://hdl.handle.net/10044/1/49968
DOI: https://dx.doi.org/10.1016/j.jcmg.2016.09.027
ISSN: 1936-878X
Publisher: Elsevier
Start Page: 1042
End Page: 1052
Journal / Book Title: JACC: Cardiovascular Imaging
Volume: 10
Issue: 9
Copyright Statement: © 2017 by the American College of Cardiology Foundation. Published by Elsevier. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: National Institute for Health Research
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: RDA07 79560
RDC04 79560
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Radiology, Nuclear Medicine & Medical Imaging
Cardiovascular System & Cardiology
arterial graft
large-vessel vasculitis
MR angiography
positron emission tomography
Takayasu arteritis
1102 Cardiovascular Medicine And Haematology
1103 Clinical Sciences
Cardiovascular System & Hematology
Publication Status: Published
Appears in Collections:National Heart and Lung Institute