One-stop shopping 18F-FDG PET/CT in a patient with vascular type Behçet’s disease

Abstract

A 43-year-old woman with a history of vascular type Behçet’s disease presented prolonged worsening edema in the upper body. A transaxial contrast enhanced computed tomography (CT) image (A) shows contrast defect in the superior vena cava (SVC) (arrow). The 3D volume rendered image (B) shows markedly enlarged intercostal veins and inferior epigastric vein of the right chest wall consistent with collateral vessels. In early dynamic scan, positron emission tomography (PET)/CT emission scanning of the chest region with a 1-min acquisition was per formed beginning s imul taneous ly wi th Ffluorodeoxyglucose (FDG) bolus injection. F-FDG was injected from the right median cubital vein. To evaluate hemodynamics and vascular anatomical structures, each 3 s time frame was reconstructed during the first 1 min. Static scan was performed 120 min after FFDG injection. PET/CT angiography images (maximum intensity projection images, a: 0–3 s, b: 4–6 s, c: 7–9 s, d: 10–12 s, e: 13–15 s, f: 16–18 s, g: 19–21 s) reveal blood flow to SVC from the right subclavian vein via the intercostal veins and enlarged collateral vessels similar to the findings on contrast enhanced CT. A static F-FDG PET/CT fused image shows no abnormal uptake of SVC wall (h). In vascular inflammatory diseases such as Behçet’s disease, Takayasu aortitis or giant cell aortitis, dilatation or occlusion of vessels sometimes occurs. Although scintiangiography was previously used for evaluating vascular disorders [1], it has been abandoned due to its low spatial resolution. CT angiography is useful in detecting structural changes such as aneurysm, dissection and stenosis, especially during disease follow-up [2]. Recently, Drescher and Freesmeyer introduced the usefulness of PET/CT angiography using early dynamic PET/CT [3–7]. They clearly visualized the aorta and its main branches on PET/CT angiography. On the other hand, F-FDG PET/CT is a known useful imaging tool in the evaluation of the activity of vascular inflammations [8, 9]. F-FDG PET/CT angiography can be performed as part of PET/CT examinations indicated for metabolic evaluation without adding any acute risks to the patient. FFDG PET/CT can be a Bone stop shopping^ imaging modality for vascular inflammatory disorders, especially large vessel vasculitis.