Rev Esp Med Nucl Imagen Mol.

2015;34(6):372–377

Special collaboration

Use of positron emission tomography (PET) for the diagnosis

of large-vessel vasculitis
J. Loricera a , R. Blanco a , J.L. Hernández b , I. Martínez-Rodríguez c , J.M. Carril c , C. Lavado c ,
M. Jiménez c , C. González-Vela d , M.Á. González-Gay a,∗
a
Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
b
Division of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
c
Division of Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
d
Division of Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

a r t i c l e i n f o a b s t r a c t

Keywords: The term vasculitis encompasses a heterogeneous group of diseases that share the presence of inflamma-
Positron emission tomography tory infiltrates in the vascular wall. The diagnosis of large-vessel vasculitis is often a challenge because
Aortitis the presenting clinical features are nonspecific in many cases and they are often shared by different
Large-vessel vasculitis
types of autoimmune and inflammatory diseases including other systemic vasculitides. Moreover, the
pathogenesis of large-vessel vasculitis is not fully understood. Nevertheless, the advent of new imaging
techniques has constituted a major breakthrough to establish an early diagnosis and a promising tool to
monitor the follow-up of patients with largevessel vasculitis. This is the case of the molecular imaging
with the combination of positron emission tomography with computed tomography (PET/CT) using dif-
ferent radiotracers, especially the 18 F-fluordeoxyglucose (18 F-FDG). In this review we have focused on
the contribution of 18 F-FDG PET in the diagnosis of large-vessel vasculitis.
© 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Utilización de la tomografía por emisión de positrones (PET) para el

diagnóstico de vasculitis de vaso grande

r e s u m e n

Palabras clave: El término vasculitis engloba un heterogéneo grupo de enfermedades que tienen en común la presencia
Tomografía por emisión de positrones de un infiltrado inflamatorio en la pared vascular. El diagnóstico de las vasculitis de vaso grande es a
Aortitis menudo dificultoso debido a que pueden comenzar con una sintomatología inespecífica que también
Vasculitis de vaso grande
puede aparecer en otros tipos de enfermedades autoinmunes e inflamatorias, incluyendo otras vasculitis
sistémicas. Además, la patogenia de las vasculitis de vaso grande no se conoce en su totalidad. Sin embargo,
el desarrollo de nuevas técnicas de imagen constituye un gran avance para establecer un diagnóstico
precoz y son una herramienta prometedora para el seguimiento de las vasculitis de vaso grande. Este es
el caso de la imagen molecular obtenida de la combinación de la tomografía por emisión de positrones
con la tomografía computarizada (PET/TAC) utilizando diferentes radiotrazadores, especialmente la 18 F-
fluordeoxiglucosa (18 F-FDG). En esta revisión nos hemos centrado en la contribución del 18 F-FDG PET en
el diagnóstico de las vasculitis de vaso grande.
© 2015 Elsevier España, S.L.U. y SEMNIM. Todos los derechos reservados.

Introduction In this regard, elevated FDG-uptake by activated macrophages and

Otto Warburg showed that cancer cells had an increased aerobic
glycolysis. Fluordeoxyglucose (FDG) is usually used to trace glucose
metabolism.1 Most tumor cells are FDG-avid. Because of that, the
PET/CT has improved the diagnostic accuracy in oncology. More-
over, FDG-uptake use is not only limited to cancer but it may be
also utilized in different conditions associated with inflammation.
∗ Corresponding author.
E-mail address: miguelaggay@hotmail.com (M.Á. González-Gay).
by newly formed granulation tissue was demonstrated by Kubota
et al.2 In addition, numerous cytokines and growth factors act on
the inflammatory cells and transform them into activated cells. This
process results in an increase in the expression and the affinity of
the glucose transporters, mainly GLUT-1 and GLUT-3, and greater
production of glycolytic enzymes such as hexokinase. It also results
in an increase of 18 F-FDG uptake.3 Nevertheless, 18 F-FDG PET alone
does not provide a good spatial resolution. For this reason, 18 F-FDG
PET is usually complemented by CT (18 F-FDG PET/CT), and a com-
bination of precise anatomic localization and functional status of
metabolically active lesions is achieved overlaying the two images
in a single image.3,4

http://dx.doi.org/10.1016/j.remn.2015.07.002
2253-654X/© 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.
 J. Loricera et al. / Rev Esp Med Nucl Imagen Mol. 2015;34(6):372–377
Usefulness of molecular imaging with PET in rheumatology
Early diagnosis and effective therapy can improve the out-
come of many rheumatic diseases. In the last decade a number
of studies have emphasized the usefulness of PET in the diagno-
sis of rheumatic diseases such as systemic vasculitis, polymyalgia
rheumatica, sarcoidosis, rheumatoid arthritis, idiopathic juvenile
arthritis, and systemic lupus erythematosus. In this article we will
focus on the use PET in large-vessel vasculitis.
Large-vessel vasculitis
18 F-FDG PET/CT plays an important role as a non-invasive tool
for the diagnosis and management of patients with large-vessel
vasculitis by providing a metabolic functional image of the vessel
wall inflammation before structural changes can be observed.3,5–10
This technique is especially helpful in atypical presentations of
vasculitis.11
Aortitis is the inflammation of aortic wall and it can be idio-
pathic or associated with a cluster of large-vessel infectious and
non-infectious diseases.11,12 In turn, non-infectious aortitis may
be of unknown etiology or associated with well-defined entities.11
The most common well-characterized underlying causes of non-
infectious aortitis are giant cell arteritis (GCA) and Takayasu
arteritis (TakA), which are primary large-vessel vasculitides.11,13–15
However, non-infectious aortitis is often an underrecognized
condition usually presenting with non-specific symptoms. For
this reason, a high degree of clinical suspicion is required to
make a diagnosis of aortitis.11,12 The presenting symptoms are
often non-specific and include fever, asthenia and abdominal
or back pain along with raised erythrocyte sedimentation rate
(ESR) or serum C-reactive protein (CRP) levels.11 Early diagno-
sis is very important to prevent the development of serious
complications such as aneurysms, dissection and rupture of the
aorta.12,13,16,17 The use of 18 F-FDG PET/CT has improved the accu-
racy of diagnosis and management of large-vessel vasculitis.11,18
According to data from different studies, 18 F-FDG sensitivity to
make an early detection of active arterial inflammation ranges
between 60% and 92%, whereas the specificity ranges between
88% and 100%.19–21 In this sense, we reported 32 cases diag-
nosed with non-infectious aortitis in our center in a 4-year period.
Thirty-one of them were diagnosed with aortitis by a positive
18 F-FDG uptake in PET/CT.11 In our series, to improve tech-
nique performance, all patients fasted for at least 6 h before the
examination. The serum glucose level was lower than 160 mg/dL
in all patients. Whole-body FDG-PET/CT was acquired 180 min
after injection of 7 MBq/kg of 18 F-FDG, using a Biograph LSO
Pico 3D from Siemens Healthcare Molecular Imaging (Hoffman
Estates, Illinois, USA). A low dose CT scan for attenuation cor-
rection and anatomic localization was first obtained, followed by
a PET scan (acquiring 250 s/bed position). Images were recon-
structed using the ordered subsets-expectation maximization
(OSEM) algorithm (2 iterations, 8 subsets). Images were visu-
ally evaluated by two experienced nuclear medicine specialists
according to the intensity of the 18 F-FDG uptake by the vessel
wall at the supraortic trunks, thoracic aorta, abdominal aorta,
iliac arteries and femoral/tibioperoneal arteries.11 However, glu-
cose is not only stored in the vasculitic vessels but also in
atheroma plaques, which obviously reduces the specificity of
the test, although in the thoracic aorta the intensity and pat-
tern of FDG-uptake enables differentiation by the use of the
Meller visual scale, that compares the vascular FDG-uptake with
the accumulation thereof in the liver, demonstrating its valid-
ity to assess the degree of inflammation and the activity of the
disease.4,21
373
Giant cell arteritis
Giant cell arteritis (GCA) is a vasculitis of large and medium
sized arteries that affects people over 50 years. This vasculitis is
common in Europe and North America and is characterized by
the granulomatous involvement of the aorta with predilection
for the involvement of the extracranial branches of the carotid
artery.11,13,14,22,23 A serious complication of GCA is the irreversible
visual loss due to ischemic optic neuropathy.13,24 Aortitis may also
occur as well as the development of aortic aneurysms.11,13,16,25 In
this regard, the use of new imaging techniques over the past 20
years has disclosed that extracranial large vessel involvement in
GCA is more common than initially thought.26 The “gold standard”
for confirmation of the diagnosis of GCA is a biopsy of the temporal
artery showing an infiltrate of mononuclear cells and the presence
of giant multinucleated cells. However, a negative temporal artery
biopsy does not preclude the diagnosis of GCA.27
Several studies have shown an abnormal production of pro-
inflammatory cytokines such as interleukin-1 (IL-1), IL-6, IL-18,
tumor necrosis factor-␣ (TNF-␣), or interferon-␥ in inflamed arte-
rial walls of patients with GCA.13 Prieto-González et al.28 observed
that FDG-uptake by large vessels, including aorta, has a high sen-
sitivity and specificity for the diagnosis of GCA. Moreover, they
showed that the maximal standardized uptake value (SUVm) cor-
related with acute phase reactants and serum IL-6 levels. However,
PET/CT scan is not considered a routine diagnostic tool in the diag-
nosis of GCA. This technique is generally indicated in cases with
atypical presentation, in individuals with nonspecific signs and
symptoms, in relatively young patients or in those cases with typi-
cal cranial manifestation of GCA in whom a temporal artery biopsy
yielded negative results.
However, 18 F-FDG uptake is not specific for vasculitis and it does
not allow the evaluation of temporal arteries owing to its special
resolution and physiologic uptake by the brain and soft tissues,3
although the most recently introduced PET/CT cameras claim a
2.5 mm spatial resolution for the PET component under optimal
conditions, expecting that pathologic 18 F-FDG uptake in temporal
arteritis may be found.29 18 F-FDG PET has been shown to be sensi-
tive for extracranial vasculitis but not for intracranial vasculitis on
account of its poor spatial resolution.30
A meta-analysis on the usefulness of 18 F-FDG PET in the diagno-
sis of GCA revealed a pooled sensitivity of 80% and a specificity of
89%.31 18 F-FDG PET reveals abnormal uptake in the aortic arch or
large thoracic arteries in more than half of affected patients. On the
other hand, 18 F-FDG PET provides good results for the assessment
of the degree of disease extension, which allows all the large-
sized arteries to be studied in a single scan, showing more affected
regions than other imaging techniques, and providing more pre-
cise evaluation of aortic involvement. Fig. 1 shows the case of a
woman diagnosed with GCA who developed an aneurysm in the
ascending aorta. Blockmans et al.32 assessed FDG-uptake in the
different vascular beds and in the large joints from a series of 35
patients with GCA at diagnosis, during steroid treatment and at
relapse, observing that FDG-uptake in the large-vessels was a sen-
sitive marker for GCA, although it was not useful to discriminate
the patients with relapses from the remaining patients without
relapses of the vasculitis. The same group of authors highlighted
that in a series of series of 46 patients with biopsy-proven GCA the
increased FDG-uptake in the aorta predisposed to develop thoracic
aortic dilatation.33
Several criteria have been proposed to establish a qualitative
assessment of FDG-PET in the detection of large vessels involve-
ment in GCA. They range from increased circumferential 18 F-FDG
uptake in a segment of the arterial wall to equal or more intense
vascular wall uptake than liver uptake.21,34–36 Recently, Puppo et al.
performed a systematic review, including a total of 442 patients
374 J. Loricera et al. / Rev Esp Med Nucl Imagen Mol. 2015;34(6):372–377

Fig. 1. A 63-year-old woman diagnosed with giant cell arteritis (GCA) by a positive temporal artery biopsy. During the follow-up (6 years after the diagnosis of GCA) an
aneurysm involving the ascending aorta was disclosed by a CT-scan. An 18 F-FDG PET/CT performed for suspicion of aortitis associated with GCA disclosed intense 18 F-FDG
uptake involving the thoracic aorta. Sagittal (A and C), axial (B) and coronal (D) 18 F-FDG PET views.

with GCA, and 535 controls to analyze the different qualitative
and semiquantitative methods for assessing the presence and grad-
ing the severity of GCA-related vascular inflammation on 18 F-FDG
PET. These authors indicate that the qualitative analysis of 18 F-FDG
uptake is the most widely accepted method for assessing the pres-
ence and grading the activity of GCA-related vascular inflammation
on 18 F-FDG PET.37 In addition, they observed that qualitative meth-
ods are more specific than the semiquantitative procedures. On the
other hand, the same group suggested that the normalization of the
arterial wall uptake to the background activity of venous blood pool
may provide a good reference to assess vascular inflammation.37
Lensen et al.38 evaluated the interobserver agreement and diag-
of atypical findings such as low back pain, pain of polymyal-
gia symptoms involving mainly the legs, particularly in people in
the fifties and sixties, sometimes associated to mild elevation of
acute phase reactants, were the alarm signs to suspect an underly-
ing aortitis. In addition, PMR manifestations have been associated
with aortitis in the setting of well-defined conditions such as sar-
coidosis or ulcerative colitis.49,50 In the cases with atypical onset
and with normal or discordant inflammatory analytical parame-
ters, 18 F-FDG PET/CT provided better information on the extension
of the vascular involvement and in some cases it allowed us to
establish the presence of a relapse of the disease. In this regard,
18 F-FDG PET/CT in patients with PMR shows a pattern of abnor-

nostic accuracy of 18 F-FDG PET for the detection of large-vessel
affection in GCA. They concluded that the use of a predefined stan-
dardized criteria consisting of the comparison of vascular uptake to
the liver uptake reached high interobserver agreement and proba-
bly had good diagnostic accuracy for large-vessel vasculitis.
Polymyalgia rheumatica and polymyalgia-like conditions
PMR is a common disorder in people over 50 years of age from
Western countries.11,22,23 It is more prevalent than GCA, and it may
present as an isolated condition or associated with typical ischemic
manifestations of GCA.11,39,40 PMR may also be the presenting man-
ifestation of GCA,11,39–42 and clinical features of PMR are present in
40–50% patients with biopsy-proven GCA.42 Several reports have
emphasized the presence of aortitis in some cases presenting as an
isolated PMR.43–45
The diagnosis of PMR is very straightforward when typical fea-
tures, such as pain in the neck, and shoulder and pelvic girdles,
are present.46,47 However, the presence of atypical symptoms or
a poor response to corticosteroids should be considered alarm
signs for the presence of a condition mimicking this disease but
different from isolated PMR.48 It was also the case for some of
our patients diagnosed with aortitis. In these cases, the presence
mally increased 18 F-FDG uptake in the soft tissues and ligaments
around the shoulders and hips, lumbar and, sometimes, cervical
spinous processes and ischial tuberosities.29 18 F-FDG PET/CT may
also provide an alternative diagnostic procedure and will likely con-
tribute to the early diagnosis of spondyloarthritides in PMR.29 Fig. 2
illustrates the findings of a patient with PMR with affection of large
vessels.
Both large-vessel vasculitis and PMR may be detected, in the
early onset of the disease by 18 F-FDG PET/CT. Our group reported
the case of a 69-year-old woman diagnosed with PMR. Prednisone
yielded an improvement of PMR symptoms. However, she started
to complain of asthenia, abdominal cramping and pain on the left
side, weight loss and bloody diarrhea 1 year after prednisone dis-
continuation. At that time a colonoscopy confirmed a diagnosis of
left-sided ulcerative colitis. She suffered many relapses of the ulcer-
ative colitis that required admission and treatment with high dose
of corticosteroids and azathioprine. Because of that a colectomy
was performed. Four months later, she started to feel dull and achy
pain in the thighs along with claudication of the lower extrem-
ities. An 18 F-FDG PET/CT revealed an inflammatory process with
moderate increased FDG-uptake in the thoracic aorta and markedly
increased metabolism in the femoral and posterior tibial arteries on
both limbs.50 On the other hand, our group49 also reported the case
 J. Loricera et al. / Rev Esp Med Nucl Imagen Mol. 2015;34(6):372–377
Fig. 2. An 83-year-old man with polymyalgia rheumatica. Due to poor corticosteroid response and persistent elevation of erythrocyte sedimentation rate and C-reactive
protein aortitits was suspected. An 18 F-FDG PET disclosed the presence of an underlying aortitis with increased FDG uptake metabolism in the thoracic aorta, supraaortic
trunks, and femoral/tibioperoneal arteries. Sagittal (A and D), axial (B) and coronal (C) 18 F-FDG PET views and maximum intensity projection image of the lower extremities
(E).
of a 56-year-old man who presented to the rheumatology outpa-
tient clinic due to a flare of PMR. Almost 2 years before, he had been
diagnosed as having isolated PMR, because of a 5-month-history of
pain and aching involving the neck, the shoulder and the pelvic
girdle, as well as proximal aspects of arms and legs, along with
morning stiffness and elevation of inflammatory laboratory mark-
ers (acute phase reactants). Owing to the presence of a refractory
disease and the development of atypical symptoms such as fever,
severe inflammatory low back pain, dull and achy pain in the thighs,
claudication of the lower extremities and bad response to corti-
costeroids and methotrexate, an 18 F-FDG PET/CT was performed.
This technique disclosed an arteritis of large-vessel involving the
ascending, arch and descending aorta and high FDG-uptake in the
femoral and posterior tibial arteries of both lower limbs. Further-
more, increased metabolism was observed in the right paratracheal,
retrotracheal, subcarinal, gastrohepatic ligament, celiac and right
renal hiliar lymph nodes. Four lymph nodes, taken during medi-
astinoscopy disclosed a diagnosis of sarcoidosis.49 In our report on
32 patients with non-infectious aortitis, the findings of 18 F-FDG
PET/CT were crucial for the correct diagnosis of aortitis in patients
presenting with PMR, mainly in those with atypical symptoms.11
Takayasu arteritis (TakA)
TakA is a large-vessel vasculitis characterized by a chronic gran-
ulomatous, inflammatory and stenotic disease, mainly affecting
the aorta and its main branches.14 It is more frequent in Asi-
atic women aged 20–40 years.14 Early diagnosis is important to
prevent irreversible structural changes. The American College of
Rheumatology established in 1990 a series of clinical, radiologi-
cal and histological classification criteria for large-vessel vasculitis,
with a sensitivity of 91.2% and 97.8% for TakA.51 These criteria are
still applied nowadays. However, many patients with TakA do not
meet these classification criteria as they often present with non-
specific clinical signs and symptoms.52 The role of 18 F-FDG PET/CT
in the assessment of disease activity and progression of TakA was
reviewed by Direskeneli et al.53 Karapolat et al. published a cross-
sectional study of 22 patients with TakA and assessed the clinical
disease by the combination of National Institutes of Health (NIH)
criteria, Disease Extent Index-Takayasu (DEI-Tak) score, physician
375
global assessment and 18 F-FDG PET/CT. These authors observed
that 18 F-FDG PET/CT findings were generally consistent with the
clinical disease status in patients with TakA.54 Moreover, these
authors disclosed that the mean 18 F-FDG PET values did not have
a correlation with ESR and CRP. This fact was also described by
Tombetti et al.55 Interestingly, the duration of the disease was
shorter in 18 F-FDG PET/CT positive patients, which may be due to
long-term suppression of vascular inflammation as the result of
immunosuppressive treatment.54
18 F-FDG PET, either alone or in combination with contrast
enhanced CT or MRA, has emerged as a potential tool for the initial
diagnosis and assessment of disease activity of aortitis caused by
TakA with a variable sensitivity ranging between 60% and 90% and
a specificity between 77% and 100%. In addition, 18 F-FDG PET/CT
has proved to be useful to monitor treatment response.12,19,20,56–59
A meta-analysis showed that this technique has moderate value to
establish TakA activity.56 We have assessed seven patients diag-
nosed with TakA who were treated with tocilizumab (TCZ). The
involvement of the aorta and its main branches was verified by
imaging techniques (PET/CT in five of them).14 Although angiogra-
phy has been considered the gold standard procedure to diagnose
TakA, it is an invasive tool and because of that it has been replaced
by other techniques, such as angio-CT scan, MRI, ultrasonography
or PET/CT.
TakA may also affect pulmonary arteries. In this regard, a study
showed abnormal pulmonary perfusion scintigraphy findings in
57% of unselected patients with TakA, whereas only 21% had pul-
monary symptoms.60 With respect to this, Addimanda et al. have
suggested that although PET/CT is very sensitive to disclose active
TakA, it cannot adequately visualize the pulmonary arteries and, a
complementary imaging technique such as pulmonary perfusion
scintigraphy, CT-angiography or magnetic resonance angiogra-
phy is required to assess pulmonary artery abnormalities in TakA
patients.61
Idiopathic aortitis
Idiopathic or isolated aortitis is a disorder characterized by
giant cells or lymphoplasmacytic inflammation of the aorta.62 Two
related entities have been described: isolated idiopathic thoracic
376 J. Loricera et al. / Rev Esp Med Nucl Imagen Mol. 2015;34(6):372–377
aortitis and chronic periaortitis that encompass disorders such as
idiopathic retroperitoneal fibrosis (Ormond disease), inflammatory
abdominal aortic aneurysm, perianeurysmal aortitis and idiopathic
isolated abdominal periaortitis.11 Isolated aortitis usually mani-
fests as an aneurysm of the ascending aorta and it is often disclosed
during the histopathological study of the aortic wall after tho-
racic surgery.62 Nevertheless, it may also present with symptoms
related to aortic inflammation. We have recently reported two
patients with idiopathic aortitis.11 In both cases PET/CT findings
were crucial to establish a diagnosis of aortitis. The first patient
was a 64-year-old man with fever and dyspnea of 1 month dura-
tion. On admission the patient was febrile and wheezes were
heard over both lungs. Moreover, acute phase reactants (inflamma-
tory laboratory markers) were elevated. A temporal artery biopsy
yielded negative results. Thoracic and abdominal CT-scans and
CT-angiography revealed emphysematous lungs with small bul-
lae in upper lobes and a bronchoscopy disclosed slightly enlarged
left paratracheal lymph nodes. The biopsy revealed reactive lym-
phadenitis. An 18 F-FDG PET/CT showed an increased FDG-uptake in
the paratracheal and hiliar lymphadenopathies in the prevascular
region. Furthermore, an increased FDG-uptake was also observed
in the thoracic and abdominal aorta, supraaortic vessels and iliac
arteries.11 The other patient was sent to the Rheumatology Division
due to chest pain, inflammatory low back pain and a constitutional
syndrome. The acute phase reactants were also raised and leukocy-
tosis and high serum levels of creatinine and urea were also present.
A body-CT scan disclosed diffuse atherosclerosis with aortocoro-
nary calcification and an elongated aorta. A 18 F-FDG PET/CT showed
homogeneous and diffuse increased FDG-uptake in the thoracic
aorta, supraaortic vessels and large vessels of lower limbs.11
Aortitis related to other diseases
Besides the cases of sarcoidosis and ulcerative colitis that we
described above, we have also found other entities in which
18 F-FDG PET/CT was useful to disclose the presence of vasculi-
tis involving the aorta and/or its major branches.11 In this sense,
we described the case of a 71-year-old woman who had previ-
ously been diagnosed with Sjögren’s syndrome. She started on
corticosteroids, but she always had persistently high erythro-
cyte sedimentation rate (ESR) levels. An 18 F-FDG PET/CT showed
increased vascular uptake with a typical pattern suggestive of
aortitis.11 We also reported the case of a 79-year-old woman with
Sjögren’s syndrome. This patient also had persistently elevated
ESR and anemia. 18 F-FDG PET/CT showed an increased FDG-uptake
in the thoracic aortic wall.11 We also described a 45-year-old
man with psoriatic arthritis who was in clinical remission fol-
lowing anti-tumor necrosis factor-monoclonal antibody-infliximab
therapy. However, the patient suffered a stroke and began with
wandering body pains, as well as a burning sensation located in the
lateral region of the left lower extremities. For this reason, an 18 F-
FDG PET/CT was performed. This technique disclosed abnormally
increased FDG-uptake in the ascending and descending thoracic
aorta, aortic arch and supraaortic vessels.11
Conclusion
Large arteries are commonly involved in patients with large-
blood vessel vasculitis. GCA and TakA are the main primary
large-vessel systemic vasculitis involving the aorta and its major
branches. Classically the diagnosis of these two large-vessel vas-
culitis has been based on the presence of typical clinical features
along with the histopathologic confirmation by a temporal artery
biopsy in cases of GCA or by the presence of abnormal angiogra-
phy findings in those with TakA. Nevertheless, imaging techniques
have emerged as a useful tool for the diagnosis, in particular in
those presenting with atypical manifestations, and the follow-up of
patients with large-vessel vasculitis. Among them, 18 F-FDG PET/CT
has shown promising results in the study of large-vessel vasculi-
tis, in particular in patients with idiopathic aortitis and to establish
the presence of aortitis in individuals with well-defined inflamma-
tory conditions who stat to complain of non-specific symptoms or
clinical manifestations unrelated to these conditions. Regardless of
the etiology, 18 F-FDG PET/CT is useful for the diagnosis, assessment
of the degree of activity, extension and follow-up of patients with
aortitis.
Funding
This study was supported by a grant from “Fondo de Inves-
tigaciones Sanitarias” PI12/00193 (Spain). This work was also
partially supported by RETICS Programs, RD08/0075 (RIER) and
RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain).
Conflict of interest
The authors declare no conflict of interest.
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