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F-18-fluorodeoxyglucose positron emission tomography-computed tomography for the diagnosis of Takayasu's arteritis in stroke: a case report.

Haensch CA, Röhlen DA, Isenmann S - J Med Case Rep (2008)

Bottom Line: Laboratory data were consistent with an inflammatory reaction.While abdominal contrast-enhanced computed tomography showed an aneurysm of the infrarenal aorta, only F-18-fluorodeoxyglucose positron emission tomography-computed tomography revealed pathology (that is, intense F-18-fluorodeoxyglucose accumulation) in the carotid arteries, ascending aorta and the abdominal aorta cranial to the aneurysm.After treatment with high-dose prednisone followed by cyclophosphamide, the signs of systemic inflammation decreased and F-18-fluorodeoxyglucose uptake was reduced as compared with the initial scan.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology, HELIOS-Klinikum Wuppertal and University of Witten/Herdecke, Wuppertal, Germany. carl-albrecht.haensch@helios-kliniken.de

ABSTRACT

Introduction: Diagnosis of Takayasu's arteritis as the cause of stroke is often delayed because of non-specific clinical presentation. F-18-fluorodeoxyglucose positron emission tomography-computed tomography may help to accurately diagnose and monitor Takayasu's arteritis in stroke patients.

Case presentation: We report the case of a left middle cerebral artery stroke in a 39-year-old man. Laboratory data were consistent with an inflammatory reaction. While abdominal contrast-enhanced computed tomography showed an aneurysm of the infrarenal aorta, only F-18-fluorodeoxyglucose positron emission tomography-computed tomography revealed pathology (that is, intense F-18-fluorodeoxyglucose accumulation) in the carotid arteries, ascending aorta and the abdominal aorta cranial to the aneurysm. After treatment with high-dose prednisone followed by cyclophosphamide, the signs of systemic inflammation decreased and F-18-fluorodeoxyglucose uptake was reduced as compared with the initial scan.

Conclusion: F-18-fluorodeoxyglucose positron emission tomography-computed tomography showed inflammatory activity in the aorta and carotid arteries, suggestive of Takayasu's arteritis in a young stroke patient, and follow-up under immunosuppressive therapy indicated reduced F-18-fluorodeoxyglucose uptake. F-18-fluorodeoxyglucose positron emission tomography-computed tomography appears to be useful in detecting and quantifying the extent of vascular wall activity in systemic large-vessel vasculitis.

No MeSH data available.


Related in: MedlinePlus

F-18-fluorodeoxyglucose positron emission tomography-computed tomography maximum intensity projection images.
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Figure 2: F-18-fluorodeoxyglucose positron emission tomography-computed tomography maximum intensity projection images.

Mentions: The head CT showed a demarcated infarction in the left middle cerebral artery territory. A subsequent MRI scan also revealed a subacute left-sided pontine infarction. Magnetic resonance angiography demonstrated no abnormalities of the cerebral vessels (Figure 1B). While transcranial and extracranial ultrasound was normal, abdominal CT showed an aneurysm of the infrarenal aorta with a diameter of 4.8 cm and a marginal thrombus (Figure 1C and 1D). CT angiography of the coronary arteries was normal. Transthoracic and transesophageal echocardiography and hypercoagulability state (proteins C and S, factor V Leiden mutation, homocysteine level, and lupus anticoagulant) were unremarkable. Laboratory studies revealed increases in ESR (46 mm/hour), CRP (47 mg/l), C3-complement levels (194 mg/dl) and hypergammaglobulinemia (1.11 g/dl). MPO/P-ANCA, C-ANCA and rheumatoid factors were negative. Cerebrospinal fluid protein level (94 mg/dl) was increased without intrathecal synthesis of immunoglobulins. For suspected arteritis and to detect systemic inflammatory disease, whole body scans in one session on a dual modality positron emission tomography (PET)-computed tomography system were performed 60 minutes after intravenous administration of 243MBq 18F-FDG. PET and CT images were reconstructed in coronal, sagittal, and transverse planes (Figures 1A and 2).


F-18-fluorodeoxyglucose positron emission tomography-computed tomography for the diagnosis of Takayasu's arteritis in stroke: a case report.

Haensch CA, Röhlen DA, Isenmann S - J Med Case Rep (2008)

F-18-fluorodeoxyglucose positron emission tomography-computed tomography maximum intensity projection images.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3300079&req=5

Figure 2: F-18-fluorodeoxyglucose positron emission tomography-computed tomography maximum intensity projection images.
Mentions: The head CT showed a demarcated infarction in the left middle cerebral artery territory. A subsequent MRI scan also revealed a subacute left-sided pontine infarction. Magnetic resonance angiography demonstrated no abnormalities of the cerebral vessels (Figure 1B). While transcranial and extracranial ultrasound was normal, abdominal CT showed an aneurysm of the infrarenal aorta with a diameter of 4.8 cm and a marginal thrombus (Figure 1C and 1D). CT angiography of the coronary arteries was normal. Transthoracic and transesophageal echocardiography and hypercoagulability state (proteins C and S, factor V Leiden mutation, homocysteine level, and lupus anticoagulant) were unremarkable. Laboratory studies revealed increases in ESR (46 mm/hour), CRP (47 mg/l), C3-complement levels (194 mg/dl) and hypergammaglobulinemia (1.11 g/dl). MPO/P-ANCA, C-ANCA and rheumatoid factors were negative. Cerebrospinal fluid protein level (94 mg/dl) was increased without intrathecal synthesis of immunoglobulins. For suspected arteritis and to detect systemic inflammatory disease, whole body scans in one session on a dual modality positron emission tomography (PET)-computed tomography system were performed 60 minutes after intravenous administration of 243MBq 18F-FDG. PET and CT images were reconstructed in coronal, sagittal, and transverse planes (Figures 1A and 2).

Bottom Line: Laboratory data were consistent with an inflammatory reaction.While abdominal contrast-enhanced computed tomography showed an aneurysm of the infrarenal aorta, only F-18-fluorodeoxyglucose positron emission tomography-computed tomography revealed pathology (that is, intense F-18-fluorodeoxyglucose accumulation) in the carotid arteries, ascending aorta and the abdominal aorta cranial to the aneurysm.After treatment with high-dose prednisone followed by cyclophosphamide, the signs of systemic inflammation decreased and F-18-fluorodeoxyglucose uptake was reduced as compared with the initial scan.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology, HELIOS-Klinikum Wuppertal and University of Witten/Herdecke, Wuppertal, Germany. carl-albrecht.haensch@helios-kliniken.de

ABSTRACT

Introduction: Diagnosis of Takayasu's arteritis as the cause of stroke is often delayed because of non-specific clinical presentation. F-18-fluorodeoxyglucose positron emission tomography-computed tomography may help to accurately diagnose and monitor Takayasu's arteritis in stroke patients.

Case presentation: We report the case of a left middle cerebral artery stroke in a 39-year-old man. Laboratory data were consistent with an inflammatory reaction. While abdominal contrast-enhanced computed tomography showed an aneurysm of the infrarenal aorta, only F-18-fluorodeoxyglucose positron emission tomography-computed tomography revealed pathology (that is, intense F-18-fluorodeoxyglucose accumulation) in the carotid arteries, ascending aorta and the abdominal aorta cranial to the aneurysm. After treatment with high-dose prednisone followed by cyclophosphamide, the signs of systemic inflammation decreased and F-18-fluorodeoxyglucose uptake was reduced as compared with the initial scan.

Conclusion: F-18-fluorodeoxyglucose positron emission tomography-computed tomography showed inflammatory activity in the aorta and carotid arteries, suggestive of Takayasu's arteritis in a young stroke patient, and follow-up under immunosuppressive therapy indicated reduced F-18-fluorodeoxyglucose uptake. F-18-fluorodeoxyglucose positron emission tomography-computed tomography appears to be useful in detecting and quantifying the extent of vascular wall activity in systemic large-vessel vasculitis.

No MeSH data available.


Related in: MedlinePlus