• Taryn Youngstein, Enrico Tombetti, Jaita Mukherjee, Tara D Barwick, Adil Al-Nahhas, Emyr Humphreys, Julian Nash, Jacqueline Andrews, Elena Incerti, Elisabetta Tombolini, Annalaura Salerno, Silvia Sartorelli, Giuseppe A Ramirez, Maurizio Papa, Maria Grazia Sabbadini, Luigi Gianolli, Francesco De Cobelli, Federico Fallanca, Elena Baldissera, Angelo A Manfredi, Maria Picchio, and Justin C Mason.
• Cardiovascular Sciences and Rheumatology Units, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
• JACC Cardiovasc Imaging. 2017 Sep 1; 10 (9): 1042-1052.

ObjectivesThis study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV).BackgroundThe role of 18F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([18F]FDG-PET/CT) in the management of LVV remains to be defined. Although [18F]FDG uptake at arterial graft sites raises concerns regarding active arteritis or infection, its clinical significance in LVV has never been formally studied.MethodsAn observational prospective study sought to identify patients with Takayasu arteritis (TA) undergoing [18F]FDG-PET/CT more than 6 months after graft surgery from a large cohort of patients from 2 tertiary referral centers. [18F]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 [18F]FDG uptake in active disease was compared with that in inactive disease, and arterial progression was assessed by prospective magnetic resonance angiography (MRA).ResultsTwenty-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 [18F]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 [18F]FDG uptake was unrelated to disease activity. Despite the high frequency of graft-associated [18F]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.ConclusionsSignificant [18F]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.Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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