Journal List > J Rheum Dis > v.24(1) > 1100119

Choi, Jung, Jung, Kim, Han, and Bang: Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Diagnosis and Assessment of Takayasu Arteritis and Ulcerative Colitis

Abstract

Takayasu arteritis (TA) and ulcerative colitis (UC), both immunemediated inflammatory diseases, rarely occur together. This report describes TA in a 29-year old female patient who was being treated for UC for three years. As she had left-side neck pain and headache, she was diagnosed with TA and her response to tumor necrosis factor (TNF) inhibitor was assessed by fluo-rine-18-fluorodeoxyglucose (18 F-FDG) positron emission tomography (PET)/computed tomography (CT). Positive responses to the TNF inhibitor were seen by PET/CT for the TA and by endoscopy for the UC. We conclude that TNF inhibitors are effective treatments for both TA and UC. We found that PET/CT is a useful for diagnosing and assessing TA.

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Figure 1.
(A) Neck computed tomography images showing bilateral common carotid arteries, subclavian arteries, and aortic arch (arrows) surrounded by soft tissue density with enhancement, with left side of both common carotid arteries and subclavian arteries being more severe than the other side. (B) Angiographic images representing that the vertebral artery as well as the bilateral common carotid arteries and subclavian arteries were abnormally narrow as well (arrows).
jrd-24-55f1.tif
Figure 2.
(A) Sigmoidoscopy which is done before the administration of the infliximab, representing a loss of vessel wall, redness of mucosa and spontaneous bleeding (black arrows). (B) Positron emission tomography (PET)/computed tomography (CT) before the administration of the infliximab. There is increase of uptake of fluorodeoxyglucose at both common carotid arteries, subclavian arteries and thoracic and abdominal aorta (white arrow). (C) Sigmoidoscopy after 3 months of the treatment, although the redness of mucosa was still left, the spontaneous bleeding disappeared. (D) PET/CT after 3 months of the treatment. The uptake of both common carotid arteries, subclavian artery and aorta baseline have been decreased (arrow).
jrd-24-55f2.tif
Table 1.
The table of cases with TA and UC in terms of diagnostic tool, treatment and follow up
Case [reference] Diagnostic tool Initial treatment Biologic therapy Other treatment Follow up tool
Possemato et al. [4] N/A Mycophenolate Infliximab, adalimumab, tocilizumab None Contract enhanced ultrasound, PET/CT
Pyo et al. [8] CT, angiography, PET/CT Prednisolone (50 mg/d), AZA (50 mg) None None NA
Takahashi et al. [9] CT, MRI Prednisolone (20 mg/d),5-ASA (2,250 mg/d) None None NA
Sood et al. [12] Angiography Steroid, sulfasalazine None None NA
Horai et al. [13] CT Prednisolone (30 mg/d) None None NA
Sy et al. [14] NA 5-ASA, prednisolone, 6-mercaptopurine Adalimumab None NA
  NA 5-ASA, prednisolone, methotrexate None None NA
  NA 5-ASA, prednisolone, 6-mercaptopurine None None NA
  NA Prednisolone None None NA
Katsinelos et al. [15] Angiography Prednisolone (50 mg/d),5-ASA, AZA None Ticlopidine hydrochloride 75 mg/d NA
Horai et al. [10] CT, Angiography Prednisolone (30 mg/d) None Warfarin NA

Note that we have utilized PET/CT as an assessment and follow up tool, for the coexistence of TA and UC. TA: Takayasu arteritis, UC: ulcerative colitis, NA: not available, PET/CT: positron emission tomography/computed tomography, AZA: azathioprine, ASA: amino salicylic acid.

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