Diagnosis and follow up of aortitis in the elderly

Abstract

Methods: Eight patients with aortitis presenting with unspecific GCA-like symptoms were examined. Aortitis was diagnosed and followed up by [¹⁸F]FDG-PET and MRI. The aorta was divided into three vascular regions (ascending aorta, aortic arch, and descending aorta) to localise the aortic inflammation and compare both imaging techniques. Results were correlated with clinical and laboratory examinations.

Results: At diagnosis, 20/24 vascular regions from eight patients were positive by [¹⁸F]FDG-PET scan and 15/21 aortic regions by MRI. Patients were treated with corticosteroids and followed up for a mean (SD) of 13.3 (4.7) months. In [¹⁸F]FDG-PET, 11/20 (55%) initially pathological aortic regions returned to normal in the follow up examination, which correlated closely with the clinical and laboratory follow up examination. Conversely, in MRI, 14/15 initially affected vascular regions were unchanged.

Conclusions: [¹⁸F]FDG-PET and MRI are both effective techniques for detecting early aortitis and have a high correlation with laboratory inflammatory measures. However, during the follow up examination, [¹⁸F]FDG-PET uptake decreased in line with the clinical symptoms and inflammatory serum markers, whereas MRI scans gave more static results.

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Figure 1.

 PET and MRI images of a female patient with aortitis (64 years) at the time of diagnosis (A and C) and 3 months later (B and D). (A) and (B) display PET images of a 64 year old patient. Compared with liver tissue, an uptake can be visualised at the ascending aorta, aortic arch, descending (black arrows) and abdominal aorta (A). Three months later there is still an uptake at the ascending aorta aortic arch and descending aorta (arrow). However, comparing the uptake with liver tissue, we see an uptake of equal intensity, interpreted as improvement of the aortic inflammation (B). (C) and (D) show MRI images of the same patient with contrast agent enhancement of the aortic wall (descending aorta) of equal intensity (white arrows) at both times indicating the more "static" results obtained with that imaging technique. The grey arrow in A depicts unspecific staining of the heart.