Imaging features of ¹⁸F-FDG PET/CT in different types of systemic vasculitis

To analyze ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) image features in different types of systemic vasculitis and explore its classification and diagnostic significance for systemic vasculitis.

Clinical and ¹⁸F-FDG PET/CT imaging data of 71 consecutive patients (34 males, 37 females, mean age 53.4 ± 20.5 years) who were examined at Peking University People’s Hospital and diagnosed with active systemic vasculitis were analyzed retrospectively, and ¹⁸F-FDG PET/CT imaging features of different types of systemic vasculitis were analyzed in patients with positive ¹⁸F-FDG PET/CT findings.

The proportions of large-, medium-, small-, and variable-vessel vasculitis were 36.6%, 15.5%, 29.6%, and 18.3%, respectively, and 93.0% of patients had positive findings on PET/CT, of which 63.6% had vascular involvement and 53.0% had extravascular involvement. Different types of vasculitis had different lesion sites, distribution patterns, and morphological changes. Large-vessel vasculitis mainly affected the aorta and its branches to the head and neck. Takayasu arteritis showed segmental involvement of the vascular and morphological changes of the vessel wall. Giant cell arteritis manifested as diffuse vascular involvement, which usually involved the temporal artery and the abdominal aorta and its branches. Medium-vessel vasculitis polyarteritis nodosa manifested as diffuse vascular involvement of both lower extremities. Small-vessel vasculitis anti-neutrophil cytoplasmic antibody-associated vasculitis manifested as granulomatous inflammation of extravascular regions. Variable-vessel vasculitis Behcet’s disease involved both blood vessels and extravascular regions.

Different types of systemic vasculitis show characteristic manifestations in ¹⁸F-FDG PET/CT images, which may be useful for the diagnosis and classification of systemic vasculitis.