Hybrid/Multimodality Cardiovascular Imaging in Large Vessel Vasculitis

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 18534

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Medical Imaging Center, Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
Interests: cardiovascular diseases; PET/CT; SPECT/CT; (hybrid) imaging; multimodality imaging
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Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, DK 8200 Aarhus, Denmark
Interests: PET; nuclear cardiology; inflammatory diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Large vessel vasculitis (LVV) is the most common form of primary vasculitis comprising giant cell arteritis (GCA), Takayasu arteritis (TAK) and aortitis. The field of GCA and LVV has undergone rapid expansion. Ultrasound-guided fast-track strategies have led to a reduction of irreversible vision loss, and the concept of imaging confirmed large vessel (LV-)GCA with or without cranial disease, has been added to the disease definition. Based on these considerations, the importance of multimodality imaging modalities including ultrasound, MRI, CT and [18F]-fluorodeoxyglucose positron emission tomography (PET)/CT has steadily increased. These techniques enable the assessment of cranial and extracranial arteries and the aorta and are less invasive, more sensitive and more quickly available than temporal artery biopsy (TAB) and conventional angiography, which have been the sole diagnostic standards in GCA and TAK, respectively, for decades. For monitoring of LVV activity during and after treatment, related biomarker measurements would be helpful, however specific serum biomarkers are lacking. Multimodality imaging can play a central role in this.

This Special Issue aims to present the role of non-invasive imaging modalities in the diagnosis and imaged-based therapeutic management of large vessel vasculitis, with a particular attention not only to the standard of care, but also for relevant developments for the near future. We encourage authors to submit both preclinical and clinical studies in the field. Clinical studies may include systematic reviews/meta-analysis, retrospective studies, and prospective studies emphasizing the role and need of imaging techniques in primary diagnosis, treatment-response, and disease relapse.

Prof. Dr. Riemer H.J.A. Slart
Prof. Dr. Lars C. Gormsen
Guest Editors

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Keywords

  • Large vessel vasculitis
  • Diagnosis
  • Therapy response
  • Multimodality imaging
  • PET/CT
  • SPECT/CT
  • CT
  • MRI
  • Ultrasound

Published Papers (10 papers)

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Research

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11 pages, 3537 KiB  
Article
Multimodality Imaging in Cranial Giant Cell Arteritis: First Experience with High-Resolution T1-Weighted 3D Black Blood without Contrast Enhancement Magnetic Resonance Imaging
by Jane Maestri Brittain, Michael Stormly Hansen, Jonathan Frederik Carlsen, Andreas Hjelm Brandt, Lene Terslev, Mads Radmer Jensen, Ulrich Lindberg, Henrik Bo Wiberg Larsson, Steffen Heegaard, Uffe Møller Døhn, Oliver Niels Klefter, Anne Katrine Wiencke, Yousif Subhi, Steffen Hamann and Bryan Haddock
Diagnostics 2024, 14(1), 81; https://doi.org/10.3390/diagnostics14010081 - 29 Dec 2023
Viewed by 832
Abstract
In order to support or refute the clinical suspicion of cranial giant cell arteritis (GCA), a supplemental imaging modality is often required. High-resolution black blood Magnetic Resonance Imaging (BB MRI) techniques with contrast enhancement can visualize artery wall inflammation in GCA. We compared [...] Read more.
In order to support or refute the clinical suspicion of cranial giant cell arteritis (GCA), a supplemental imaging modality is often required. High-resolution black blood Magnetic Resonance Imaging (BB MRI) techniques with contrast enhancement can visualize artery wall inflammation in GCA. We compared findings on BB MRI without contrast enhancement with findings on 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/low-dose computed tomography (2-[18F]FDG PET/CT) in ten patients suspected of having GCA and in five control subjects who had a 2-[18F]FDG PET/CT performed as a routine control for malignant melanoma. BB MRI was consistent with 2-[18F]FDG PET/CT in 10 out of 10 cases in the group with suspected GCA. In four out of five cases in the control group, the BB MRI was consistent with 2-[18F]FDG PET/CT. In this small population, BB MRI without contrast enhancement shows promising performance in the diagnosis of GCA, and might be an applicable imaging modality in patients. Full article
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14 pages, 4616 KiB  
Article
Myocardial and Vascular Involvement in Patients with Takayasu Arteritis: A Cardiovascular MRI Study
by Simin Almasi, Sanaz Asadian, Leila Hosseini, Nahid Rezaeian, Shakiba Ghasemi asl, Abdolmohammad Ranjbar, Seyyed-Reza Sadat-Ebrahimi, Behnaz Mahmoodieh and Alireza Salmanipour
Diagnostics 2023, 13(23), 3575; https://doi.org/10.3390/diagnostics13233575 - 30 Nov 2023
Cited by 1 | Viewed by 843
Abstract
We aimed to explore the cardiovascular magnetic resonance (CMR) of Takayasu arteritis (TA) and its cardiovascular complications. CMR was conducted on 37 TA patients and 28 healthy individuals. We evaluated the CMR findings and adverse cardiovascular complications at the time of the CMR [...] Read more.
We aimed to explore the cardiovascular magnetic resonance (CMR) of Takayasu arteritis (TA) and its cardiovascular complications. CMR was conducted on 37 TA patients and 28 healthy individuals. We evaluated the CMR findings and adverse cardiovascular complications at the time of the CMR (ACCCMR). After 8 to 26 months, the major adverse cardiac and cerebrovascular events (MACCEs) were evaluated. The TA included 25 women (67.6%), aged 36 ± 16 years old, and 28 age- and sex-matched healthy controls. Left ventricular (LV) ejection fraction was significantly lower in the TA group than in the control group (51 ± 9% vs. 58 ± 1.7%; p < 0.001). Aortic mural edema was present in 34 patients (92%) and aortic mural hyperenhancement in 36 (97%). Left ventricular global longitudinal strain (LVGLS) was significantly lower in the TA group (median [interquartile range] = 13.70 [3.27] vs. 18.08 [1.35]; p < 0.001). ACCCMR was seen in 13 TA patients (35.1%), with the most common cardiac complication being myocarditis (16.2%). During a median follow-up of 18 months (8–26 months), nine patients developed MACCEs, of which the most common was cerebrovascular accident in five (13.5%). The LVGLS of the CMR had the strongest association with complications. Myocardial strain values, especially LVGLS, can reveal concurrent and future cardiovascular complications in TA patients. Full article
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12 pages, 3914 KiB  
Article
[18F]FDG PET/CT in Large Vessel Vasculitis: The Impact of Expertise and Confounders on Image Analysis
by Lidija Antunovic, Alessia Artesani, Michael Coniglio, Wim J. G. Oyen, Michele Ciccarelli, Carlo Selmi, Arturo Chiti and Martina Sollini
Diagnostics 2022, 12(11), 2717; https://doi.org/10.3390/diagnostics12112717 - 07 Nov 2022
Viewed by 1502
Abstract
Background: Diagnosis of vasculitis is challenging. To avoid invasive approaches, clinical guidelines recommend the use of diagnostic imaging. This study aimed at evaluating the diagnostic accuracy of [18F]-fluorodeoxyglucose ([18F]FDG) position emission tomography/computed tomography (PET/CT) in large vessel vasculitis (LVV) [...] Read more.
Background: Diagnosis of vasculitis is challenging. To avoid invasive approaches, clinical guidelines recommend the use of diagnostic imaging. This study aimed at evaluating the diagnostic accuracy of [18F]-fluorodeoxyglucose ([18F]FDG) position emission tomography/computed tomography (PET/CT) in large vessel vasculitis (LVV) and how this is affected by inter-operator variability. Methods: A total of 279 patients who performed [18F]-FDG PET/CT for suspicion of LVV were retrospectively analyzed. We tested the qualitative and semi-quantitative analysis and parameters influencing image quality and interpretation. Exams were evaluated by two readers with different experience and their performance was compared. Results: LVV diagnosis was confirmed in 81 patients. [18F]-FDG PET/CT accuracy was 73% and 67% for the expert reader and less experienced reader, respectively. The expert reader overall performed better than the less experienced one, with higher accuracy in patients with normal BMI (77.3 vs. 63.8%), normal level of glycemia (73.3 vs. 65%), younger age (76.6 vs. 68.2%), and when no therapy was in course at time of imaging (76.7 vs. 66.7%). The diagnostic performance of both readers did not improve using semi-quantitative parameters. Conclusions: We confirmed the appropriateness of the recommended criteria for image acquisition and interpretation, underlining the importance of experience in image interpretation for the optimal diagnostic performance of [18F]FDG PET/CT in vasculitis. Full article
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12 pages, 3138 KiB  
Article
Whole-Body [18F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease
by Matthias Fröhlich, Sebastian Serfling, Takahiro Higuchi, Martin G. Pomper, Steven P. Rowe, Marc Schmalzing, Hans-Peter Tony, Michael Gernert, Patrick-Pascal Strunz, Jan Portegys, Eva-Christina Schwaneck, Ottar Gadeholt, Alexander Weich, Andreas K. Buck, Thorsten A. Bley, Konstanze V. Guggenberger and Rudolf A. Werner
Diagnostics 2021, 11(11), 2073; https://doi.org/10.3390/diagnostics11112073 - 09 Nov 2021
Cited by 4 | Viewed by 1989
Abstract
The 2-deoxy-d-[18F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely utilized to assess the vascular and articular inflammatory burden of patients with a suspected diagnosis of rheumatic disease. We aimed to elucidate the impact of [18F]FDG PET/CT on change [...] Read more.
The 2-deoxy-d-[18F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely utilized to assess the vascular and articular inflammatory burden of patients with a suspected diagnosis of rheumatic disease. We aimed to elucidate the impact of [18F]FDG PET/CT on change in initially suspected diagnosis in patients at the time of the scan. Thirty-four patients, who had undergone [18F]FDG PET/CT, were enrolled and the initially suspected diagnosis prior to [18F]FDG PET/CT was compared to the final diagnosis. In addition, a semi-quantitative analysis including vessel wall-to-liver (VLR) and joint-to-liver (JLR) ratios was also conducted. Prior to [18F]FDG PET/CT, 22/34 (64.7%) of patients did not have an established diagnosis, whereas in 7/34 (20.6%), polymyalgia rheumatica (PMR) was suspected, and in 5/34 (14.7%), giant cell arteritis (GCA) was suspected by the referring rheumatologists. After [18F]FDG PET/CT, the diagnosis was GCA in 19/34 (55.9%), combined GCA and PMR (GCA + PMR) in 9/34 (26.5%) and PMR in the remaining 6/34 (17.6%). As such, [18F]FDG PET/CT altered suspected diagnosis in 28/34 (82.4%), including in all unclear cases. VLR of patients whose final diagnosis was GCA tended to be significantly higher when compared to VLR in PMR (GCA, 1.01 ± 0.08 (95%CI, 0.95–1.1) vs. PMR, 0.92 ± 0.1 (95%CI, 0.85–0.99), p = 0.07), but not when compared to PMR + GCA (1.04 ± 0.14 (95%CI, 0.95–1.13), p = 1). JLR of individuals finally diagnosed with PMR (0.94 ± 0.16, (95%CI, 0.83–1.06)), however, was significantly increased relative to JLR in GCA (0.58 ± 0.04 (95%CI, 0.55–0.61)) and GCA + PMR (0.64 ± 0.09 (95%CI, 0.57–0.71); p < 0.0001, respectively). In individuals with a suspected diagnosis of rheumatic disease, an inflammatory-directed [18F]FDG PET/CT can alter diagnosis in the majority of the cases, particularly in subjects who were referred because of diagnostic uncertainty. Semi-quantitative assessment may be helpful in establishing a final diagnosis of PMR, supporting the notion that a quantitative whole-body read-out may be useful in unclear cases. Full article
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12 pages, 951 KiB  
Article
Intracranial Involvement in Takayasu’s Arteritis
by Andrea Johnson, Derek Emery and Alison Clifford
Diagnostics 2021, 11(11), 1997; https://doi.org/10.3390/diagnostics11111997 - 27 Oct 2021
Cited by 9 | Viewed by 2049
Abstract
Takayasu’s arteritis (TAK) is a large-vessel vasculitis that targets the aorta and its major branches. Although extracranial vascular involvement is uniformly present in this disease, the frequency of intracranial involvement in TAK has not been well studied. We retrospectively reviewed the clinical and [...] Read more.
Takayasu’s arteritis (TAK) is a large-vessel vasculitis that targets the aorta and its major branches. Although extracranial vascular involvement is uniformly present in this disease, the frequency of intracranial involvement in TAK has not been well studied. We retrospectively reviewed the clinical and imaging records of patients diagnosed with TAK at a single Canadian university medical centre to determine the prevalence of intracranial vascular involvement. Intracranial vascular and non-vascular findings were described, and a review of the literature was performed. Of 20 patients with TAK, 12 had vascular neuroimaging completed. Intracranial vascular lesions were identified in 4 patients (33.3% of those with imaging available, 20% of all patients). The frequency of intracranial vessel involvement in TAK may be more common than appreciated. Imaging of both the intra- and extra-cranial vessels should be considered in these young patients. Full article
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13 pages, 1319 KiB  
Article
Toward Reliable Uptake Metrics in Large Vessel Vasculitis Studies
by Gijs D. van Praagh, Pieter H. Nienhuis, Daniel M. de Jong, Melanie Reijrink, Kornelis S. M. van der Geest, Elisabeth Brouwer, Andor W. J. M. Glaudemans, Bhanu Sinha, Antoon T. M. Willemsen and Riemer H. J. A. Slart
Diagnostics 2021, 11(11), 1986; https://doi.org/10.3390/diagnostics11111986 - 26 Oct 2021
Cited by 6 | Viewed by 1275
Abstract
The aim of this study is to investigate the influence of sex, age, fat mass, fasting blood glucose level (FBGL), and estimated glomerular filtration rate (eGFR) on blood pool activity in patients with large vessel vasculitis (LVV). Blood pool activity was measured in [...] Read more.
The aim of this study is to investigate the influence of sex, age, fat mass, fasting blood glucose level (FBGL), and estimated glomerular filtration rate (eGFR) on blood pool activity in patients with large vessel vasculitis (LVV). Blood pool activity was measured in the superior caval vein using mean, maximum, and peak standardized uptake values corrected for body weight (SUVs) and lean body mass (SULs) in 41 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans of LVV patients. Sex influence on the blood pool activity was assessed with t-tests, while linear correlation analyses were used for age, fat mass, FBGL, and eGFR. Significantly higher SUVs were found in women compared with men, whereas SULs were similar between sexes. In addition, higher fat mass was associated with increased SUVs (r = 0.56 to 0.65; all p < 0.001) in the blood pool, but no correlations were found between SULs and fat mass (r = −0.25 to −0.15; all p > 0.05). Lower eGFR was associated with a higher FDG blood pool activity for all uptake values. In FDG-PET/CT studies with LVV patients, we recommend using SUL over SUV, while caution is advised in interpreting SUV and SUL measures when patients have impaired kidney function. Full article
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11 pages, 631 KiB  
Article
Vessel Wall Inflammatory Activity as Determined by F-18 Fluorodeoxyglucose PET in Large Vessel Vasculitis Is Attenuated by Immunomodulatory Drugs
by Romilda Sherzay, Torsten Witte, Thorsten Derlin, Marius Hoepfner and Frank M. Bengel
Diagnostics 2021, 11(7), 1132; https://doi.org/10.3390/diagnostics11071132 - 22 Jun 2021
Cited by 2 | Viewed by 1642
Abstract
F-18 fluorodeoxyglucose (F-18 FDG) PET/CT plays an increasing role in the diagnostic workup of large vessel vasculitis (LVV); however, information on the relationship between immunosuppressive drugs and vessel wall uptake is limited. In 94 patients with a confirmed diagnosis of LVV, the vessel [...] Read more.
F-18 fluorodeoxyglucose (F-18 FDG) PET/CT plays an increasing role in the diagnostic workup of large vessel vasculitis (LVV); however, information on the relationship between immunosuppressive drugs and vessel wall uptake is limited. In 94 patients with a confirmed diagnosis of LVV, the vessel wall-to-liver ratio (VLR) was assessed in eight vessel segments. Patients were grouped according to intake of immunomodulatory drugs (Group 1, prednisone; Group 2, prednisone + methotrexate; and Group 3, prednisone + others) and compared to treatment-naïve individuals. A total of 54/94 (57.4%) were treated with immunomodulatory drugs (Group 1, 29/49 (53.7%); Group 2, 9/54 (16.7%); Group 3, 11/54 (20.4%); and Group 4, 5/54 (9.3%)), whereas the remainder received no therapy (40/94 (42.6%)). The mean VLR of the arterial segments correlated significantly with the hematopoietic organs (r ≥ 0.22, p ≤ 0.05), c-reactive protein (r ≥ 0.25, p ≤ 0.05), and prednisone dosage (r ≥ −0.4, p ≤ 0.05). Relative to treatment-naïve patients, a significantly lower VLR was recorded in 5/8 (62.5%) of the investigated vessel segments in Group 1 (p ≤ 0.02), in 6/8 of the vessel segments in Group 2 (75.0%, p ≤ 0.006), and in 7/8 of the segments in Group 3 (87.5%, p ≤ 0.05). In LVV, the F-18 FDG uptake in vessel wall as a marker of inflammatory activity was attenuated by immunomodulatory drugs, which provides a foundation for future serial monitoring of treatment efficacy. Full article
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Review

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9 pages, 254 KiB  
Review
Semi-Quantitative and Quantitative [18F]FDG-PET/CT Indices for Diagnosing Large Vessel Vasculitis: A Critical Review
by Olivier Gheysens, François Jamar, Andor W. J. M. Glaudemans, Halil Yildiz and Kornelis S. M. van der Geest
Diagnostics 2021, 11(12), 2355; https://doi.org/10.3390/diagnostics11122355 - 14 Dec 2021
Cited by 13 | Viewed by 2191
Abstract
To confirm the diagnosis of large vessel vasculitis (LVV) with high accuracy, one of the recommended imaging techniques is [18F]Fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography ([18F]FDG-PET/CT). Visual assessment of [18F]FDG uptake in the arterial wall compared [...] Read more.
To confirm the diagnosis of large vessel vasculitis (LVV) with high accuracy, one of the recommended imaging techniques is [18F]Fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography ([18F]FDG-PET/CT). Visual assessment of [18F]FDG uptake in the arterial wall compared to liver uptake is the mainstay for diagnosing LVV in routine clinical practice. To date, there is no consensus on the preferred semi-quantitative or quantitative parameter for diagnosing LVV. The aim of this review is to critically update the knowledge on the available evidence of semi-quantitative and quantitative [18F]FDG uptake parameters for diagnosing LVV and to provide future directions for methodological standardization and research. Full article
30 pages, 2895 KiB  
Review
PET-Based Imaging with 18F-FDG and 18F-NaF to Assess Inflammation and Microcalcification in Atherosclerosis and Other Vascular and Thrombotic Disorders
by William Y. Raynor, Peter Sang Uk Park, Austin J. Borja, Yusha Sun, Thomas J. Werner, Sze Jia Ng, Hui Chong Lau, Poul Flemming Høilund-Carlsen, Abass Alavi and Mona-Elisabeth Revheim
Diagnostics 2021, 11(12), 2234; https://doi.org/10.3390/diagnostics11122234 - 29 Nov 2021
Cited by 11 | Viewed by 2959
Abstract
Positron emission tomography (PET) imaging with 18F-fluorodeoxyglucose (FDG) represents a method of detecting and characterizing arterial wall inflammation, with potential applications in the early assessment of vascular disorders such as atherosclerosis. By portraying early-stage molecular changes, FDG-PET findings have previously been shown [...] Read more.
Positron emission tomography (PET) imaging with 18F-fluorodeoxyglucose (FDG) represents a method of detecting and characterizing arterial wall inflammation, with potential applications in the early assessment of vascular disorders such as atherosclerosis. By portraying early-stage molecular changes, FDG-PET findings have previously been shown to correlate with atherosclerosis progression. In addition, recent studies have suggested that microcalcification revealed by 18F-sodium fluoride (NaF) may be more sensitive at detecting atherogenic changes compared to FDG-PET. In this review, we summarize the roles of FDG and NaF in the assessment of atherosclerosis and discuss the role of global assessment in quantification of the vascular disease burden. Furthermore, we will review the emerging applications of FDG-PET in various vascular disorders, including pulmonary embolism, as well as inflammatory and infectious vascular diseases. Full article
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Other

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3 pages, 2059 KiB  
Interesting Images
Bilateral Vertebral Artery Vasculitis—A Rare Manifestation of Giant Cell Arteritis and a Difficult Diagnosis Made Possible by 2-[18F]FDG PET/CT
by Natasja Degn Justesen, Michael Stormly Hansen, Mads Radmer Jensen, Oliver Niels Klefter, Jane Maestri Brittain and Steffen Hamann
Diagnostics 2021, 11(5), 879; https://doi.org/10.3390/diagnostics11050879 - 14 May 2021
Cited by 2 | Viewed by 1924
Abstract
Giant cell arteritis (GCA) is the most common form of large vessel vasculitis. GCA is a medical and ophthalmological emergency, and rapid diagnosis and treatment with high-dose corticosteroids is critical in order to reduce the risk of stroke and sudden irreversible loss of [...] Read more.
Giant cell arteritis (GCA) is the most common form of large vessel vasculitis. GCA is a medical and ophthalmological emergency, and rapid diagnosis and treatment with high-dose corticosteroids is critical in order to reduce the risk of stroke and sudden irreversible loss of vision. GCA can be difficult to diagnose due to insidious and unspecific symptoms—especially if typical superficial extracranial arteries are not affected. In these cases, verification of clinical diagnosis using temporal artery biopsy is not possible. This example illustrates the diagnostic value of hybrid imaging with 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT), and the limitations of the temporal artery biopsy in bilateral vertebral GCA, causing transient ischemic attack in the visual cortex. In addition it indicates that inflammation in the artery wall can be visualized on 2-[18F]FDG PET/CT despite long term and ongoing high dose glucocorticoid treatment. Full article
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