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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

Follow-up 18F-FDG PET-CT study revealed reduced wall enhancement under immunosuppressive therapy. (A), (B) Resolution of fluorodeoxyglucose uptake after immunosuppressive treatment. (C), (D) T2-weighted images and magnetic resonance angiography appear normal except for infrarenal aorta aneurysm. (E) Improvement of metabolism in the left temporal region.
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Figure 3: Follow-up 18F-FDG PET-CT study revealed reduced wall enhancement under immunosuppressive therapy. (A), (B) Resolution of fluorodeoxyglucose uptake after immunosuppressive treatment. (C), (D) T2-weighted images and magnetic resonance angiography appear normal except for infrarenal aorta aneurysm. (E) Improvement of metabolism in the left temporal region.

Mentions: In a follow-up 18F-FDG PET-CT study after 2 months the patient revealed reduced wall enhancement in the aorta (maximal SUV = 2.93) and in the left carotid artery (maximal SUV = 2.47) under immunosuppressive therapy. Unchanged increased glucose utilization was found in the right carotid artery (maximal SUV = 3.6). MRI and magnetic resonance angiography showed no abnormalities besides the infrarenal aneurysm at this time (Figure 3).


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)

Follow-up 18F-FDG PET-CT study revealed reduced wall enhancement under immunosuppressive therapy. (A), (B) Resolution of fluorodeoxyglucose uptake after immunosuppressive treatment. (C), (D) T2-weighted images and magnetic resonance angiography appear normal except for infrarenal aorta aneurysm. (E) Improvement of metabolism in the left temporal region.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Follow-up 18F-FDG PET-CT study revealed reduced wall enhancement under immunosuppressive therapy. (A), (B) Resolution of fluorodeoxyglucose uptake after immunosuppressive treatment. (C), (D) T2-weighted images and magnetic resonance angiography appear normal except for infrarenal aorta aneurysm. (E) Improvement of metabolism in the left temporal region.
Mentions: In a follow-up 18F-FDG PET-CT study after 2 months the patient revealed reduced wall enhancement in the aorta (maximal SUV = 2.93) and in the left carotid artery (maximal SUV = 2.47) under immunosuppressive therapy. Unchanged increased glucose utilization was found in the right carotid artery (maximal SUV = 3.6). MRI and magnetic resonance angiography showed no abnormalities besides the infrarenal aneurysm at this time (Figure 3).

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