Diagnostic agreement between clinical criteria and disease activity in Takayasu’s arteritis by 2-[18F]FDG PET-CT scan

Document Type : Original Article


1 Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Nuclear Medicine Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran



Introduction: Large Vessel Vasculitis (LVV) is a chronic inflammatory process that affects the aorta and its main branches. LVV include Takayasu’s Arteritis (TA) and Giant Cell Arteritis (GCA). The diagnosis of TA is made according to clinical criteria and based on the criteria of the American College of Rheumatology (ACR). Monitoring of disease progression and response to treatment is also done using the National Institutes of Health (NIH) criteria. Despite these criteria, diagnosing and evaluating TA activity is a challenging issue and usually occurs in the advanced stages of the disease. The lack of a comprehensive and non-invasive diagnostic method for diagnosing and monitoring the course of TA is obvious. The aim of this study was to evaluate the diagnostic agreement between 2-[18F]FDG PET-CT scan and clinical criteria for assessing TA disease activity. 
Methods: Twenty-four known cases of TA, who met the inclusion criteria, were enrolled in this study. The disease-related constitutional signs and symptoms, as well as laboratory and imaging findings were recorded. Patients underwent 2-[18F]FDG PET-CT imaging with standard protocol. Fused PET-CT images were reviewed and, if necessary, images without attenuation correction were visualized as well. Also, 24 control patients of the same age and sex, among the patients who were referred to the imaging center for oncological indications were examined to compare the uptake of different vascular territories.
Results: Out of 15 active patients (according to the NIH criteria), 2-[18F]FDG PET-CT scan was able to correctly identify 14 patients. Also, out of 9 inactive patients, PET scan was negative in eight patients showing that 2-[18F]FDG PET-CT scan could well differentiate between active and inactive status of the disease (p-value < 0.0001). Sensitivity, specificity, positive predictive value and negative predictive value of scan in this study were 93.3%, 88.9%, 93.3% and 88.9%, respectively. The study also showed that the severity of vascular lesion uptake was not affected by immunosuppressive drugs, including corticosteroids and methotrexate. Scan findings were comparable with the results of anatomical imaging in terms of disease activity and the number of vascular lesions with p-value = 0.1 and 0.304, respectively.
Conclusion: In this study we showed that 2-[18F]FDG PET-CT has comparable results with other imaging modalities and NIH criteria; therefore, it can play an important role in assessing the severity of TA, even when patients are on immunosuppressive drugs.


Main Subjects

  1. Mason JC. Takayasu arteritis--advances in diagnosis and management. Nat Rev Rheumatol. 2010 Jul;6(7):406-15.
  2. Onen F, Akkoc N. Epidemiology of Takayasu arteritis. Presse Med. 2017 Jul-Aug;46(7-8 Pt 2):e197-e203.
  3. de Souza AW, de Carvalho JF. Diagnostic and classification criteria of Takayasu arteritis. J Autoimmun. 2014 Feb-Mar;48-49:79-83.
  4. Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS. Takayasu arteritis. Ann Intern Med. 1994 Jun 1;120(11):919-29.
  5. Salvarani C, Cantini F, Boiardi L, Hunder GG. Laboratory investigations useful in giant cell arteritis and Takayasu's arteritis. Clin Exp Rheumatol. 2003 Nov-Dec;21(6 Suppl 32):S23-8.
  6. O'Connor TE, Carpenter HE, Bidari S, Waters MF, Hedna VS. Role of inflammatory markers in Takayasu arteritis disease monitoring. BMC Neurol. 2014 Mar 28;14:62.
  7. Shek Y, Song SS. Takayasu’s arteritis. In: Park MS, Kalani SMY, de Havenon A, McNally JS, editors. Carotid Artery Disease. 1st ed. Switzerland: Springer Cham; 2020. p. 233-45.
  8. Yamada I, Nakagawa T, Himeno Y, Kobayashi Y, Numano F, Shibuya H. Takayasu arteritis: diagnosis with breath-hold contrast-enhanced three-dimensional MR angiography. J Magn Reson Imaging. 2000 May;11(5):481-7.
  9. Slart RHJA; Writing group; Reviewer group; Members of EANM Cardiovascular; Members of EANM Infection & Inflammation; Members of Committees, SNMMI Cardiovascular; Members of Council, PET Interest Group; Members of ASNC; EANM Committee Coordinator. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging. 2018 Jul;45(7):1250-1269.
  10. Karapolat I, Kalfa M, Keser G, Yalçin M, Inal V, Kumanlioğlu K, Pirildar T, Aksu K. Comparison of F18-FDG PET/CT findings with current clinical disease status in patients with Takayasu's arteritis. Clin Exp Rheumatol. 2013 Jan-Feb;31(1 Suppl 75):S15-21.
  11. Santhosh S, Mittal BR, Gayana S, Bhattacharya A, Sharma A, Jain S. F-18 FDG PET/CT in the evaluation of Takayasu arteritis: an experience from the tropics. J Nucl Cardiol. 2014 Oct;21(5):993-1000.
  12. Serra R, Butrico L, Fugetto F, Chibireva MD, Malva A, De Caridi G, Massara M, Barbetta A, Cannistrà M, de Franciscis S. Updates in pathophysiology, diagnosis and management of Takayasu arteritis. Ann Vasc Surg. 2016 Aug;35:210-25.
  13. Russo RAG, Katsicas MM. Takayasu arteritis. Front Pediatr. 2018 Sep 24;6:265.
  14. Tezuka D, Haraguchi G, Ishihara T, Ohigashi H, Inagaki H, Suzuki J, Hirao K, Isobe M. Role of FDG PET-CT in Takayasu arteritis: sensitive detection of recurrences. JACC Cardiovasc Imaging. 2012 Apr;5(4):422-9.
  15. Cheng Y, Lv N, Wang Z, Chen B, Dang A. 18-FDG-PET in assessing disease activity in Takayasu arteritis: a meta-analysis. Clin Exp Rheumatol. 2013 Jan-Feb;31(1 Suppl 75):S22-7.
  16. Soussan M, Nicolas P, Schramm C, Katsahian S, Pop G, Fain O, Mekinian A. Management of large-vessel vasculitis with FDG-PET: a systematic literature review and meta-analysis. Medicine (Baltimore). 2015 Apr;94(14):e622.
  17. Fan J, Wei D, Zhang H, Sun X, Cai J, Fan L, Yu J, Ma W, Song L, Zhou X. 18F-FDG PET/CT plays a unique role in the management of Takayasu arteritis patients with atypical manifestations. Clin Rheumatol. 2021 Feb;40(2):625-633.
  18. Han Q, Zhou X, ding j, et al. 18F-FDG-PET/CT plays a key role in formulating treatment strategies for Takayasu arteritis. Res Sq. 2020; in press
  19. Taimen K, Salomäki SP, Hohenthal U, Mali M, Kajander S, Seppänen M, Nuutila P, Palomäki A, Roivainen A, Pirilä L, Kemppainen J. The clinical impact of using 18F-FDG-PET/CT in the diagnosis of suspected vasculitis: the effect of dose and timing of glucocorticoid treatment. Contrast Media Mol Imaging. 2019 Aug 29;2019:9157637.
  20. Milman N, Mortensen J, Sloth C. Fluorodeoxyglucose PET scan in pulmonary sarcoidosis during treatment with inhaled and oral corticosteroids. Respiration. 2003 Jul-Aug;70(4):408-13.
  21. Ahmadian A, Pawar S, Govender P, Berman J, Ruberg FL, Miller EJ. The response of FDG uptake to immunosuppressive treatment on FDG PET/CT imaging for cardiac sarcoidosis. J Nucl Cardiol. 2017 Apr;24(2):413-424.
  22. Parihar A, Kumar R, Singh H, Mittal B. 18F-FDG PET/CT in Takayasu arteritis-Active or Inactive? J Nucl Med. 2020 May 1; 61(supplement 1): 643-643.
  23. Kang F, Han Q, Zhou X, Zheng Z, Wang S, Ma W, Zhang K, Quan Z, Yang W, Wang J, Zhu P. Performance of the PET vascular activity score (PETVAS) for qualitative and quantitative assessment of inflammatory activity in Takayasu's arteritis patients. Eur J Nucl Med Mol Imaging. 2020 Dec;47(13):3107-3117.
  24. Janes ALF, Castro MF, Arraes AED, Savioli B, Sato EI, de Souza AWS. A retrospective cohort study to assess PET-CT findings and clinical outcomes in Takayasu arteritis: does 18F-fluorodeoxyglucose uptake in arteries predict relapses? Rheumatol Int. 2020 Jul;40(7):1123-1131.