Additional value of positron emission tomography in diagnosis and follow-up of patients with large vessel vasculitides.

OBJECTIVES: To determine the value of Positron Emission Tomography (PET) in the diagnosis of Takayasu arteritis (TA) and giant cell arteritis (GCA) and its value in the assessment of disease activity and response to therapy.

METHODS: In 5 consecutive patients diagnosed with TA or GCA, PET using the tracer F18-deoxyglucose (FDG) was performed when disease activity was suspected based on clinical and laboratory parameters. PET was repeated after therapeutic intervention when disease remission was achieved. PET findings were compared with angiography, MRA and clinical parameters.

RESULTS: PET visualised inflamed arteries in all 5 patients, but there was a discrepancy between PET and angiography or MRA. In 8 arteries of 4 patients only PET showed disease involvement, while in 5 arteries of 2 patients only angiography or MRA showed involvement. After treatment and the disappearance of clinical symptoms, FDG uptake was clearly reduced compared to the initial scan in all patients. In all but one the acute phase response declined. In that patient a urinary tract infection explained the elevated acute phase response, as this normalised after antibiotic treatment.

CONCLUSION: PET is a promising new technique for the diagnosis of large vessel vasculitides. Furthermore, PET appears to be a valuable tool for the assessment of disease activity during follow-up and of the response to therapy.