FDG PET in the early diagnosis of large-vessel vasculitis

Excerpt

A 59-year-old female patient with general malaise, low-grade fever and high inflammatory markers was referred for a fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan for further evaluation. Previous contrast CT scan was negative (a) and she was not on any treatment at the time of the study. A whole-body FDG PET/CT scan was performed with a time-of-flight PET scanner in the 3-D mode (b–d). Intense increased FDG uptake was extensively observed in the thoracic and abdominal aorta, subclavian, axillary, carotid and brachiocephalic arteries (bottom row). The uptake was diffuse and homogeneous involving vessels along their entire length. Maximum standardized uptake values were between 3.5 and 5.5, and the visually assessed FDG wall uptake was higher than the liver, with a score III for all segments [1, 2]. A diagnosis of large-vessel vasculitis (LVV) was made primarily based on the PET scan findings and the patient was treated with steroids and methotrexate, with complete remission of symptoms and normalization of inflammatory markers. …