title: Large vessel vasculitis in elderly patients: early diagnosis and steroid-response evaluation with FDG-PET/CT and contrast-enhanced CT.
abstract: Large vessel vasculitis (LVV) is an often-reported cause of inflammation of unknown origin (IUO) in elderly people. The objective of this study was to describe the usefulness of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and contrast-enhanced CT in early diagnosis and treatment follow-up of patients with LVV presenting as elderly onset IUO. We retrospectively compared contrast-enhanced CT findings and FDG-PET/CT findings of the patients diagnosed with LVV and 11 controls; all subjects were 50 years of age or older. We evaluated maximum standardised uptake value (SUV(max)) and PET score of the aortic wall for quantitative comparison of FDG-PET/CT findings. We measured the aortic wall thickness (W) and its ratio against the radius (W/R) for quantitative comparison of aortic wall thickening by contrast-enhanced CT. After steroid treatment, we compared these values with those pre-treatment. Of 124 patients who were hospitalised due to advanced age and IUO, 88 underwent FDG-PET/CT and contrast-enhanced CT. Abnormal findings were observed on images from 78 patients. The findings were indicative of LVV in 13 patients (10.5 %), of whom more than half had only non-specific symptoms. Patients with LVV had significantly higher aortic wall SUV(max) (3.85 vs. 1.95), PET scores by FDG-PET/CT, and aortic wall thicknesses by contrast-enhanced CT (3.8 vs. 2.6 mm) than controls. Significant improvement in aortic wall thickening was evidenced by reduced PET scores and by contrast-enhanced CT findings in patients who were followed up after treatment. LVV is an important cause of IUO with non-specific symptoms in elderly patients. Imaging examination comprising contrast-enhanced CT and FDG-PET/CT is useful for early diagnosis and early treatment evaluation of LVV, allowing for amelioration of reversible aortic wall thickening.
authors.affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo-to, 162-8655, Japan, gomuto@z6.keio.jp.
authors.forename: Go
authors.initials: G
authors.lastname: Muto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamashita
authors.forename: Yuko
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Yoko
authors.initials: Y
authors.lastname: Miyata
authors.forename: Miyako
authors.initials: M
authors.lastname: Morooka
authors.forename: Ryogo
authors.initials: R
authors.lastname: Minamimoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kubota
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaneko
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kano
authors.forename: Akio
authors.initials: A
authors.lastname: Mimori
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D042241:Early Diagnosis; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014657:Vasculitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D013256:Steroids; D019788:Fluorodeoxyglucose F18