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Peripheral vascular disease
Detection of inflammation in patients with acute aortic syndrome: comparison of FDG-PET/CT imaging and serological markers of inflammation
  1. H Kuehl1,
  2. H Eggebrecht2,
  3. T Boes3,
  4. G Antoch1,
  5. S Rosenbaum4,
  6. S Ladd1,
  7. A Bockisch4,
  8. J Barkhausen1,
  9. R Erbel2
  1. 1
    Department for Diagnostic and Interventional Radiology and Neuroradiology, Essen, Germany
  2. 2
    Department of Cardiology, West German Heart Center, Essen, Germany
  3. 3
    Institute for Medical Informatics, Biometry and Epidemiology, Essen, Germany
  4. 4
    Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany
  1. Dr Hilmar Kuehl, Department for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Hufelandstr 55, D-45122 Essen, Germany; hilmar.kuehl{at}uni-due.de

Abstract

Objective: A substantial number of patients with acute aortic syndrome (AAS) require invasive therapy because of disease progression. Our study aimed to assess the impact of positron emission tomography (PET)/computed tomography (CT) and serological markers of inflammation to identify patients at high risk for disease progression.

Methods: 33 patients with AAS (thoracic aortic aneurysm 5, thoracic aortic dissection 14, penetrating aortic ulcer 8, intramural haematoma 6) were included. After intravenous administration of [18F] fluorodeoxyglucose a non-contrast enhanced PET/CT of the body trunk and CT angiography of the entire aorta was performed. Serological levels of D-dimers and C-reactive protein (CRP) were measured in all patients. Follow-up imaging was performed to detect disease progression.

Results: 11 (33%) of 33 patients showed elevated tracer uptake within the aortic pathology, whereas 22 patients were PET-negative. In 23 patients a CRP level exceeding 1.0 mg/dl or a D-dimer level larger than 250 μg/l was found. The follow-up time was 224 (195) days. Nine of 11 PET-positive patients (82%) showed progression of AAS. In contrast, 55% of PET-negative patients showed stable disease or regression during the follow-up period. Kaplan-Meier analysis showed a clear, but not yet significant trend to longer survival in PET-negative patients, whereas elevated CRP and D-dimers did not allow for distinguishing of high-risk patients.

Conclusions: Vessel wall inflammation was found in one-third of the patients with AAS and this patient group seems to have a high risk for disease progression. These initial results needs further investigation.

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Footnotes

  • Competing interests: None.

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