The use of positron emission tomography (18F-FDG PET) in diagnosing chronic periaortitis
Authors:
P. Němec 1; Z. Řehák 2; P. Fabian 3; M. Souček 1
Authors place of work:
II. interní klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta doc. MUDr. Miroslav Souček, CSc.
1; Oddělení nukleární medicíny – centrum PET Masarykova onkologického ústavu Brno, vedoucí lékař oddělení prim. MUDr. Karol Bolčák
2; Oddělení onkologické a experimentální patologie – úsek diagnostické bioptické patologie Masarykova onkologického ústavu Brno, vedoucí lékař oddělení prim. MUDr. Rudolf Nenutil, CSc.
3
Published in the journal:
Vnitř Lék 2008; 54(11): 1093-1099
Category:
Case Report
Summary
Chronic periaortitis involving idiopathic retroperitoneal fibrosis, inflammatory aneurysm of the abdominal aorta and perianeurysmal retroperitoneal fibrosis is a rare disease characterised by the development of an inflammatory fibrotising process surrounding large vessels and organs of the retroperitoneum. According to some authors, chronic periaortitis results from a systemic autoimmune inflammation with vasculitis affecting aortal vasa vasorum and medium and small calibre retroperitoneal vessels. The disease is assumed to have immunopathogenetic background. Chronic periaortitis is diagnosed with the use of ultrasonography, computed tomography or magnetic resonance, and needle biopsy is mostly used for biopsy examinations. Positron emission tomography (PET) is a non-invasive diagnostic method which shows the biodistribution of positron emitter labelled radiopharmaceuticals in the body. Due to the fact that not only tumorous, but in certain conditions also some inflammatory cells may exhibit increased accumulation of 18F-FDG (2-[18F]-fluoro-2‑de-oxy-D-glukose, 18F-FDG PET can be used to diagnose and to ascertain the activity of some types of chronic inflammations. We report a case of a 60-year old man with idiopathic retroperitoneal fibrosis. 18F-FDG PET examination shoed an increased accumulation of the radiopharmaceutical around the abdominal aorta and of common ileac veins of the retroperitoneum. 18F-FDG PET fusion and computed tomography (CT) showed a correlation between the metabolically active tissue (PET) and the soft tissue infiltrate visible in CT images. A control exam done 4 months after the start of systemic therapy showed that the pathological accumulation of the radiopharmaceutical in the retroperitoneum had disappeared. 18F-FDG PET may be a useful tool to improve diagnosis of chronic periaortitis. A significant contribution of this method is the possibility to assess the activity of the pathologic process while monitoring the effect of the treatment.
Key words:
diagnosis – chronic periaortitis – retroperitoneal fibrosis – therapy – 18F-FDG
Zdroje
1. Mitchinson MJ. Chronic periaortitis and periarteritis. Histopathology 1984; 8: 589–600.
2. Parums DV. The spectrum of chronic periaortitis. Histopathology 1990; 16: 423–431.
3. Ormond J. Bilateral ureteral obstruction due to envelopment and compression by an inflammatory retroperitoneal process. J Urol 1948; 10: 1072–1079.
4. McDougal WS, MacDonell RC Jr. Treatment of idiopathic retroperitoneal fibrosis by immunosuppression. J Urol 1991; 145: 112–114.
5. Hoffman WW, Trippel OH. Retroperitoneal fibrosis: etiological considerations. J Urol 1961; 86: 222–231.
6. Amis ES Jr. Retroperitoneal fibrosis. AJR Am J Roentgenol 1991; 157: 321–329.
7. Parums DV, Brown DL, Mitchinson MJ. Serum antibodies to oxidized low-density lipoprotein in chronic periaortitis. Arch Pathol Lab Med 1990; 114: 383–387.
8. Vaglio A, Corradi D, Manenti L et al. Evidence of autoimmunity in chronic periaortitis: a prospective study. Am J Med 2003; 114: 454–462.
9. Littlejohn JO, Keystone EC. The association of retroperitoneal fibrosis with systemic vasculitis and HLA‑B27: a case report and review of literature. J Rheumatol 1981; 8: 665–669.
10. De La Iglesia Martinez F, Grana Gil J, Gomez Veiga F et al. The association of retroperitoneal fibrosis and ankylosing spondylitis. J Rheumatol 1992; 19: 1147–1149.
11. Ter Maaten JC, Franssen CFM, Daenekkindt AA et al. Triple Wegener’s granulomatosis in the urogenital tract. Nephron 1993; 63: 358–359.
12. De Roux-Serratrice C, Serratrice J, Granel B et al. Periaortitis heralding Wegener’s granulomatosis. J Rheumatol 2002; 29: 392–394.
13. Hautekeete ML, Babany G, Marcellin P et al. Retroperitoneal fibrosis after surgery for aortic aneurysm in a patient with periarteritis nodosa: successful treatment with corticosteroids. J Intern Med 1990; 228: 533–536.
14. Machado EBV, Michet CJ, Ballard DJ et al. Trends in incidence and clinical presentation of temporal arteritis in Olmsted County, Minnesota, 1950–1985. Arthritis Rheum 1988; 31: 745–749.
15. Rasmussen TE, Hallet JW Jr. Inflammatory aortic aneurysm – a clinical review with new perspectives in pathogenesis. Ann Surg 1997; 225: 155–164.
16. Nitecki SS, Hallett JW Jr, Stanson AW et al. Inflammatory abdominal aortic aneurysm: new clinical implication from a case-control study. J Vasc Surg 1996; 23: 860–869.
17. Tanaka S, Komori K, Okadome K et al. Detection of active cytomegalo virus infection in inflammatory aortic aneurysms with RNA polymerase chain reaction. J Vasc Surg 1994; 20: 235–243.
18. Rasmussen TE, Hallett JW Jr, Metzger RLM et al. Genetic risk factors in inflammatory abdominal aortic aneurysms: polymorphic residue 70 in the HLA‑DRB1 gene as a key genetic element. J Vasc Surg 1997; 25: 356–364.
19. Martorana D, Vaglio A, Greco P et al. Chronic periaortitis and HLA‑DRB1*03: another clue to an autoimmune origin. Arthritis Rheum 2006; 55: 126–130.
20. Artom A, Gandolfo N. Idiopathic retroperitoneal fibrosis: a case report without increased levels of acute-phase reactants. Noninvasive diagnosis and treatment. Ann Ital Med Int 2004; 19: 50–53.
21. Kubota Y, Nomura Y, Tamaki M et al. Four cases of idiopathic retroperitoneal fibrosis markedly responsive to steroid therapy. Hinyokika Kiyo 2005; 51: 315–319.
22. Hollingworth P, Denman AM, Gumpel JM. Retroperitoneal fibrosis and polyarteritis nodosa successfully treated by intensive immunosuppression. J R Soc Med 1980; 73: 61–64.
23. Maillart E, Laueriere L, Kassis S et al. Is there an evidence‑based management of idiopathic retroperitoneal fibrosis? Rev Med Interne 2006; 27: 854–857.
24. Clark CP, Vanderpool D, Preskitt JT. The response of retroperitoneal fibrosis to tamoxifen. Surgery 1991; 109: 502–506.
25. Loffeld RJ, van Weel TF. Tamoxifen for retroperitoneal fibrosis. Lancet 1993; 341: 382.
26. Frankart L, Lorge F, Donckier J. Tamoxifen for retroperitoneal fibrosis. Postgrad Med J 1997; 73: 653–654.
27. Owens LV, Cance WG, Huth JF. Retroperitoneal fibrosis treated with tamoxifen. Am Surg 1995; 61: 842–844.
28. Bourouma R, Chevet D, Michel F et al. Treatment of idiopathic retroperitoneal fibrosis with tamoxifen. Nephrol Dial Transplant 1997; 12: 2407–2410.
29. Ozener C, Kiris S, Lawrence R et al. Potential beneficial effect of tamoxifen in retroperitoneal fibrosis. Nephrol Dial Transplant 1997; 12: 2166–2168.
30. Chambers JC, McGovern K. Tamoxifen for retroperitoneal fibrosis. Palliat Med 2005; 19: 163–164.
31. Ergun I, Keven K, Canbakan B et al. Tamoxifen in the treatment of idiopathic retroperitoneal fibrosis. Int Urol Nephrol 2005; 37: 341–343.
32. van Bommel EF, Hendriksz TR, Huiskes AW et al. Brief communication: tamoxifen therapy for nonmalignant retroperitoneal fibrosis. Ann Intern Med 2006; 144: 101–106.
33. Vaglio A, Greco P, Buzio C. Tamoxifen therapy for retroperitoneal fibrosis. Ann Intern Med 2006; 144: 619.
34. Degesys GE, Dunnick NR, Silverman PM et al. Retroperitoneal fibrosis: use of CT in distinguishing among possible causes. AJR Am J Roentgenol 1986; 146: 57–60.
35. Glazer HS, Lee JK, Levitt RG et al. Radiation fibrosis: differentiation from recurrent tumor by MR imaging. Radiology 1985; 156: 721–726.
36. Yuh WT, Barloon TJ, Sickels WJ et al. Magnetic resonance imaging in the diagnosis and followup of idiopathic retroperitoneal fibrosis. J Urol 1989; 141: 602–605.
37. Dixon AK, Mitchinson MJ, Sherwood T. Computed tomographic observations in periaortitis. A hypothesis. Clin Radiol 1984; 35: 39–42.
38. Hricak H, Higgins CB, Williams RD. Nuclear magnetic resonance imaging in retroperitoneal fibrosis. AJR Am J Roentgenol 1983; 141: 35–38.
39. Wenger M, Calamia KT, Salvarani C et al. Do we need 18F‑FDG-positron emission tomography as a functional imaging technique for diagnosing large vessel arteritis? Clin Exp Rheumatol 2003; 21 (Suppl 32): S1–S2.
40. Blockmans D. The use of (18F)fluoro‑deoxyglucose positron emission tomography in the assessment of large vessel vasculitis. Clin Exp Rheumatol 2003; 21 (Suppl 32): S15–S22.
41. Řehák Z, Fojtík Z, Staníček J et al. 18F‑FDG PET v diagnostice vaskulitid velkých cév. Vnitř Lék 2006; 52: 1037–1044.
42. Řehák Z, Fryšáková L, Tichý T et al. Detekce temporální arteritidy pomocí 18F‑FDG PET. Čes Radiol 2006; 60: 234–238.
43. Salvarani C, Pipitone N, Versari A et al. Positron emission tomography (PET): Evaluation of Chronic Periaortitis. Athritis Rheum 2005; 53: 298–303.
44. Sakamoto A, Okamoto K, Ishizaka N et al. 18F‑fluorodeoxyglucose positron emission tomography in a case of retroperitoneal fibrosis. Int Heart J 2006; 47: 645–650.
Štítky
Diabetology Endocrinology Internal medicineČlánok vyšiel v časopise
Internal Medicine
2008 Číslo 11
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