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CC BY-NC-ND 4.0 · World J Nucl Med 2021; 20(01): 90-92
DOI: 10.4103/wjnm.WJNM_102_20
Case Report

18F-fluorodeoxyglucose positron emission tomography/ computed tomography of giant cell arteritis with lower extremity involvement in association with polymyalgia rheumatica

Ananya Panda
1   Department of Radiology, Mayo Clinic, Rochester, MN, USA
,
Gregory Wiseman
1   Department of Radiology, Mayo Clinic, Rochester, MN, USA
,
Matthew Koster
2   Department of Rheumatology, Mayo Clinic, Rochester, MN, USA
,
Kenneth Warrington
2   Department of Rheumatology, Mayo Clinic, Rochester, MN, USA
,
Geoffrey Johnson
1   Department of Radiology, Mayo Clinic, Rochester, MN, USA
3   Department of Radiology and Immunology, Mayo Clinic, Rochester, MN, USA
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Abstract

An 80-year-old man presented with new-onset pain in the shoulders and lower extremities and elevated serum inflammatory markers. A clinical diagnosis of polymyalgia rheumatica (PMR) was made, but there was a suboptimal response to glucocorticoid therapy, prompting further evaluation. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) revealed intense FDG uptake in the arteries of the bilateral lower extremities, head, and neck, but sparing the aorta, suggestive of an uncommon pattern of giant cell arteritis (GCA). There were also imaging signs consistent with PMR, including FDG uptake in the synovium of large joints. This case highlights the uncommon manifestation of GCA with lower extremity involvement and sparing of the aorta. The combination of FDG PET imaging features and elevated serum markers obviated the need for invasive biopsy. One might also conclude that standard FDG PET/CT imaging protocols covering orbits/vertex to thighs incompletely evaluate the extent of arterial distribution of GCA.

Keywords

Diagnosis - diagnostic imaging - giant cell arteritis - polymyalgia rheumatica - rheumatic diseases - vasculitis

Financial support and sponsorship

Nil.




Publication History

Received: 02 August 2020

Accepted: 10 August 2020

Article published online:
30 March 2022

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Kermani TA, Matteson EL, Hunder GG, Warrington KJ. Symptomatic lower extremity vasculitis in giant cell arteritis: A case series. J Rheumatol 2009;36:2277-83.
  • 2 Koster MJ, Matteson EL, Warrington KJ. Large-vessel giant cell arteritis: Diagnosis, monitoring and management. Rheumatology (Oxford, England). 2018;57(suppl_2):ii32-42.
  • 3 Le Hello C, Lévesque H, Jeanton M, Cailleux N, Galateau F, Peillon C,et al. Lower limb giant cell arteritis and temporal arteritis: Followup of 8 cases. J Rheumatol 2001;28:1407-12.
  • 4 Tatò F, Hoffmann U. Clinical presentation and vascular imaging in giant cell arteritis of the femoropopliteal and tibioperoneal arteries. Analysis of four cases. J Vasc Surg 2006;44:176-82.
  • 5 Mujukian A, Kay M, Marks JL. Symptomatic lower limb large vessel vasculitis presenting as fever of unknown origin diagnosed on FDG-PET/CT. BMJ case reports. 2018;2018.
  • 6 Kermani TA, Warrington KJ. Lower extremity vasculitis in polymyalgia rheumatica and giant cell arteritis. Curr Opin Rheumatol 2011;23:38-42.
  • 7 Blockmans D, de Ceuninck L, Vanderschueren S, Knockaert D, Mortelmans L, Bobbaers H. Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: A prospective study of 35 patients. Arthritis Rheum 2006;55:131-7.
  • 8 Fuchs M, Briel M, Daikeler T, Walker UA, Rasch H, Berg S, et al. The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging 2012;39:344-53.
  • 9 Slart RH; Writing group, Reviewer group, Members of EANM Cardiovascular, Members of EANM Infection & Inflammation, Members of Committees, SNMMI Cardiovascular,et al. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: Joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging 2018;45:1250-69.
  • 10 Besson FL, Parienti JJ, Bienvenu B, Prior JO, Costo S, Bouvard G, et al. Diagnostic performance of18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2011;38:1764-72.