Objective A substantial number of patients with acute aortic syndrome (AAS) require invasive therapy due to disease progression. Our study aimed to assess the impact of PET/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 hematoma 6) were included. After iv administration of [18F]Fluorodeoxyglucose a non-contrast enhanced PET/CT of the body trunk and CT angiography of the entire aorta was performed. Serologic levels of D-dimers and C-reactive protein 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 ig/l was found, respectively. 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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