Zhongguo quanke yixue (Mar 2022)

The Clinical Value of PET-CT in the Diagnosis of Pre-pulseless Takayasu's Arteritis Presenting as Fever of Unknown Origine

  • ZENG Keqin, YIN Yufeng, REN Tian, ZHOU Erye, WANG Mingjun, WU Jian

DOI
https://doi.org/10.12114/j.issn.1007-9572.2021.01.048
Journal volume & issue
Vol. 25, no. 08
pp. 918 – 923

Abstract

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BackgroundTakayasu's arteritis (TAK) presenting as fever of unknown origin (FUO) is rare in clinic. Diagnosis is difficult in the early stageas the non-specific clinical symptoms and signs, the lack of imaging findings of great artery stenosis and occlusionof patients. With the wide application of positron emission computed tomography/computed tomography (PET-CT) in the diagnosis and differential diagnosis of FUO, it may contribute to the early diagnosis of TAK.ObjectiveTo investigate the application value of PET-CT in the diagnosis and condition assessment of early TAK presenting as FUO.MethodsThe clinical presentations, laboratory examinations, PET-CT findings, and treatment outcomes of 7 cases of TAK presenting as FUO that eventually diagnosed by PET-CT from January 2013 to January 2021were retrospectively analyzed, and the medical literature from 1991 to 2021 was reviewed.ResultsAll the 7 patients were female, the age of onsetranging from 27 to 58 years old, with an average age of (37.9±10.6) years. The course of disease was from 1 to 6 months, with an average of (3.9±2.4) months. FUO was the first symptom of all patients (100.0%) , which may be accompanied by palpitation (14.3%) , dizziness (28.6%) , headache (14.3%) , fatigue (28.6%) and other non-specific clinical symptoms. Laboratory tests showed elevated levels of leukocytes (71.4%) , platelets (57.1%) , erythrocyte sedimentation rate (ESR) (100.0%) , C-reactive protein (CRP) (85.7%) , tumor necrosis factor-α (TNF-α) (42.9%) and interleukin-6 (IL-6) (85.7%) . Color Doppler ultrasound, computed tomography angiography (CTA) and magnetic resonance angiography (MRA) showed no stenosis and occlusion of large arteries, while PET-CT showed inflammatory changes in arterial walls at multiple locations, including thecending aorta (28.6%) , aortic arch (14.3%) , common carotid artery (28.6%) , subclavian artery (28.6%) , thoracic aorta (14.3%) , abdominal aorta (14.3%) and renal artery (14.3%) .ConclusionPET-CT is helpful in the diagnosis and condition assessment of pre-pulseless Takayasu's arteritis presenting as FUO.

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