IgG4-aortitis among thoracic aortic aneurysms

ObjectiveThe incidence of aortitis in patients with thoracic aortic diseases is not well established. The aim of this study was to analyse the frequency and clinical course of patients with aortitis in a surgical series.Methods320 consecutive patients with ascending aorta/aortic arch aneurysm or acute aortic syndrome who underwent surgery from 2012 to 2017 in a single tertiary referral hospital were retrospectively reviewed. Epidemiological data, clinical course and variables related to diagnosis, treatment and follow-up were collected from patients with histologically proven aortitis.ResultsFrom 320 examined aortic samples, 279 (87.2%) thoracic aneurysms and 41 acute aortic syndromes (12.8%), 9 (2.8%) were aortitis: 3 cases of Takayasu’s arteritis, 3 of IgG4-related aortitis, 2 of giant cell, and 1 classified as idiopathic. Median age at surgery was 53.4 (51–69.2) years and six cases were female. Seven patients presented with non-specific symptoms and the diagnosis was made at pathology. Surgery was elective in eight patients and emergent in one case of IgG4-related aortitis. 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) was performed for disease extension study and as a monitoring technique during the follow-up of five patients, with just one case performed presurgically. All the patients with IgG4-related disease showed extrathoracic aortic involvement. There were no deaths, neither in-hospital nor during the 1.7 years of median follow-up.ConclusionsIn surgically treated thoracic aorta pathology, the frequency of aortitis is low; IgG4-related disease is among the most common aetiologies with a frequency similar to other types of aortitis, such as Takayasu’s and giant cell arteritis, and clinical manifestations are non-specific making presurgical diagnosis difficult. 18F-FDG PET/CT allows a better assessment of disease extension and therapeutic response. Surgery can be successfully performed and corticosteroid therapy ensures a good mid-term follow-up.

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The utility of FDG-PET/CT and other imaging techniques in the evaluation of IgG4-related disease

Joint Bone Spine ◽

10.1016/j.jbspin.2014.01.010 ◽

2014 ◽

Vol 81 (4) ◽

pp. 331-336 ◽

Cited By ~ 31

Author(s):

Hiroyuki Takahashi ◽

Hiroyuki Yamashita ◽

Miyako Morooka ◽

Kazuo Kubota ◽

Yuko Takahashi ◽

...

Keyword(s):

Fdg Pet ◽

Imaging Techniques ◽

Related Disease ◽

Igg4 Related Disease ◽

Pet Ct ◽

Fdg Pet Ct

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Isolated involvement of thyroid gland by IgG4-related disease revealed by 18F-FDG PET/CT

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-019-04600-4 ◽

2019 ◽

Vol 47 (3) ◽

pp. 736-737

Author(s):

Yuanyuan Jiang ◽

Guozhu Hou ◽

Wuying Cheng

Keyword(s):

Thyroid Gland ◽

Fdg Pet ◽

Related Disease ◽

Igg4 Related Disease ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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18F-FDG PET/CT Features of Chronic Sclerosing Sialadenitis Presenting as Localized IgG4-Related Disease

Clinical Nuclear Medicine ◽

10.1097/rlu.0000000000001482 ◽

2017 ◽

Vol 42 (2) ◽

pp. 131-132 ◽

Cited By ~ 2

Author(s):

Nobuo Kashiwagi ◽

Eisuke Enoki ◽

Chisa Hosokawa ◽

Kenta Sakaguchi ◽

Takamichi Murakami

Keyword(s):

Fdg Pet ◽

Related Disease ◽

Chronic Sclerosing Sialadenitis ◽

Igg4 Related Disease ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Ct Features

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Clinical presentation and treatment response in patients with polymyalgia rheumatica and giant cell arteritis during a 40-week follow-up

Rheumatology Advances in Practice ◽

10.1093/rap/rkab091 ◽

2021 ◽

Author(s):

Amir Emamifar ◽

Søren Hess ◽

Torkell Ellingsen ◽

Oke Gerke ◽

Ziba Ahangarani Farahani ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Treatment Response ◽

Giant Cell ◽

Clinical Features ◽

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Temporal Artery Biopsy ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Objectives To study the clinical features of polymyalgia rheumatica and/or giant cell arteritis (PMR/GCA) and clinical predictors of treatment response during a 40-week follow-up period. Method Clinical data on 77 patients with newly diagnosed PMR/GCA who were treated by oral glucocorticoids were gathered at baseline and during 40-week follow-up period. A unilateral temporal artery biopsy (TAB) and 18 F-FDG PET/CT were undertaken at diagnosis. In total, each patient was seen at 5 occasions i.e. baseline, weeks 4, 16, 28, and 40. Treatment response was assessed considering clinical evaluations and results of inflammatory markers. Results Of 77 patients (49(63.6%) female, mean age : 71.8 ± 8.0), 64(83.1%) patients had pure PMR, 10(13.0%) concomitant PMR and GCA, and 3(3.9%) pure GCA. The patients reported clinical symptoms except scalp pain and duration of morning stiffness improved significantly at week 4 and remained lower at week 40 compared with the relative frequencies at baseline. Besides, all components of physical examination showed significant improvement and remained lower at week 40 compared with the baseline. 68.7%, 62.9%, 44.1% and 33.3% of the patients had a complete response at weeks 4, 16, 28, and 40, respectively. Several clinical features including female gender, younger age, fewer relapse, and lower level of baseline ESR were significantly associated with a better treatment response. Treatment response during follow-up period was independent of TAB results and FDG uptakes on 18 F-FDG PET/CT at diagnosis. Conclusion Obtaining valid disease specific outcome measures for evaluating treatment efficacy in PMR and GCA, that can be applied universally is clearly an unmet clinical need. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT02985424

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SAT0542 UTILITY OF QUANTITATIVE ANALYSIS OF 18FDG-PET/CT in IgG4-RELATED DISEASE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4941 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1228.1-1228

Author(s):

S. Tsuji ◽

N. Iwamoto ◽

H. Yoshiro ◽

K. Fujikawa ◽

K. Takashi ◽

...

Keyword(s):

Quantitative Analysis ◽

Fdg Pet ◽

Ct Imaging ◽

Organ Involvement ◽

Related Disease ◽

Igg4 Related Disease ◽

Biopsy Site ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct

Background:In IgG4-related diseases (IgG4-RD), usefulness of18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging for detecting the organ involvement of IgG4-RD have been shown and,18FDG PET/CT was more accurate and appeared to be more sensitive as compared to other imaging technics1,2. However, until now, the studies regarding about quantitative analysis of PET/CT imaging in IgG4-RD were few. To avoid unnecessary biopsy and select suitable lesion for biopsy on multi-organ involvement disease such as IgG4-RD, the information which lesion is suspected as disease-involvement lesion in a non-invasive test is important.Objectives:The purpose of this work is to evaluate the usefulness of18FDG-PE/CT imaging in management of IgG4-RD using quantitative analysis of PET/CT imaging.Methods:21 patients with IgG4-RD, in whom PET/CT was undertaken at the time of diagnosis between December 2009 and July 2018, were enrolled. We retrospectively investigated the association between histological findings in which biopsy was performed for diagnosis of IgG4-RD and findings of PET/CT.18FDG uptake was assessed in site of major organ involvement of IgG4-RD which could be differentiated from the normal uptake of background tissue with18FDG-PET/CT. For quantitative analysis, we measured the highest standardized uptake value (SUV) of the pixels within the region of interest (ROI) (SUVmax) and the average SUV within ROI (SUVmean). We also measured SUVmeanof liver as reference tissue. Then, we calculated ratio between SUVmeanof ROI and SUVmean/liver.Results:The age at diagnosis was 64.5 ± 11.9 years, serum IgG4 was 743.8 ± 584.1 mg/dl, and biopsy was performed at 24 sites (Submandibular gland 10, prostate gland 4, pancreas 2, thyroid gland 1, lung 1, retroperitoneum 1, kidney 1). Histological findings were consistent with IgG4RD (positive) at 19 sites.Although SUVmaxat the biopsy site was not correlated with the biopsy results, SUVmeanat the biopsy site were significantly higher in the biopsy-positive group (figure 1). As similar, SUVmean/liver SUVmeanwere also higher in the biopsy-positive group (2.17 vs 1.52, respectively P<0.05). To establish cut-off value of SUVmeanto consider biopsy, A receiver operating characteristics (ROC) curve was constructed. ROC curve analysis indicated SUVmean=4.074 as cut-off value which discriminate IgG4-RD related lesion.Conclusion:Our present study suggested that quantitative analysis of18FDG-PET/CT imaging is useful for selecting the biopsy site in IgG4-related disease.Figure 1.XXXXXReferences:[1]Ebbo M, Grados A, Guedj E, et al. Usefulness of 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography for staging and evaluation of treatment response in IgG4-related disease: a retrospective multicenter study. Arthritis Care Res (Hoboken) 2014; 66(1): 86-96.[2]Zhang J, Chen H, Ma Y, et al. Characterizing IgG4-related disease with (1)(8)F-FDG PET/CT: a prospective cohort study. Eur J Nucl Med Mol Imaging 2014; 41(8): 1624-34.Disclosure of Interests:None declared

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