Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Diagnosis and Assessment of Takayasu Arteritis and Ulcerative Colitis

Yeon-Woo Choi; Sodam Jung; Tae Yang Jung; Young Hwan Kim; Dong Soo Han; So-Young Bang

doi:10.4078/jrd.2017.24.1.55

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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

Case Report

J Rheum Dis 2017;24(1):55-59.

Published online: 31 October 2017

DOI: https://doi.org/10.4078/jrd.2017.24.1.55

Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Diagnosis and Assessment of Takayasu Arteritis and Ulcerative Colitis

Yeon-Woo Choi^1,², Sodam Jung^1,², Tae Yang Jung^1,², Young Hwan Kim^3,⁴, Dong Soo Han², So-Young Bang¹

¹Division of Rheumatology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

²Division of Gastroenterology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

³Department of Nuclear Medicine, Hanyang University College of Medicine, Seoul, Korea

⁴Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding to: So-Young Bang, Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 11923, Korea. E-mail: sybang@hanyang.ac.kr

Received 14 April 2016 revision requested 21 May 2016 Revised 27 July 2016 Accepted 12 August 2016 Accepted 16 August 2016

This is a Open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

REFERENCES

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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).

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).

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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