ANCA相关性血管炎中主动脉壁的^(18)F-FDG摄取情况分析

Aortic ^(18)F-FDG Uptake in Patients Suffering from Anti-Neutrophil Cytoplasmic Antibodies-Associated Vasculitis

目的通过^(18)F-FDG PET/CT显像评估抗中性粒细胞胞浆抗体相关性血管炎(AAV)中主动脉壁的FDG摄取情况。方法回顾性分析15例AAV患者的PET/CT影像资料,评估其主动脉壁的FDG摄取情况,另选取15例大血管炎(LVV)患者作为阳性对照组,10例体检者为健康对照组(HC组)。PET结果进行视觉和半定量分析。以上腔静脉管腔内的SUV_(mean)做为血池本底对主动脉壁的FDG摄取进行校正,得出TBR_(max)(主动脉壁的SUV_(max)/上腔静脉SUV_(mean))。以主动脉壁代谢最活跃部位的TBR_(max)及主动脉壁各节段(升主动脉、主动脉弓、降主动脉、腹主动脉)的平均TBR_(max)为半定量指标,采用单因素方差分析比较AAV组、LVV组及HC组间主动脉壁的FDG摄取差异。结果视觉分析,AAV组中主动脉壁的摄取程度主要为Ⅱ级-中摄取,与肝脏摄取相当(11例,73.3%),LVV组主要为Ⅱ级-中摄取(8例,53.3%)和Ⅲ级-高摄取,高于肝脏摄取(7例,46.7%),HC组主要为Ⅰ级-低摄取,明显低于肝脏水平(9例,90%)。半定量分析,主动脉壁代谢最活跃部位的TBR_(max)在AVV组(2.63±1.53)、LVV组(3.08±1.65)均明显高于HC组(1.51±0.24),差异有统计学意义(P=0.040<0.05,P=0.007<0.05);LVV组稍高于AVV组,但差异无统计学意义(P=0.820>0.05)。主动脉壁各节段的平均TBR_(max)在AAV组(1.99±0.42)、LVV组(2.43±0.99)均明显高于HC组(1.39±0.20),差异有统计学意义(P=0.000<0.05,P=0.003<0.05);LVV组稍高于AAV,但差异无统计学意义(P=0.328>0.05)。结论 AAV患者中主动脉壁FDG摄取明显增高,提示小血管炎可以影响到大血管的可能。^(18)F-FDG PET/CT能够准确地检出并判断AAV中合并大血管受累的情况,对该类病变患者做出全面、综合评价,具有较大优势。

Objective The objective of the study was to systematically assess aortic inflammation in patients with antineutrophil cytoplasmic antibodies-associated vasculitis using18F-FDG PET/CT.MethodsAortic inflammation was retrospectively analysed in PET/CT scans obtained from 15 patients with AAV;15 patients with large vessel vasculitis(LVV)were included as positive controls and 10 healthy people were used as healthy controls(HC).PET results were evaluated by visual and semi-quantitative analysis.Aortic18F-FDG uptake was blood-normalized by dividing the SUVmaxof the aorta by the SUVmeanof the blood pool in the vena cava,known as the TBRmax.The TBRmax of the most diseased aortic segment and the mean TBRmax of the whole aorta were compared among the three groups using one-way ANOVA analysis.Results The aortic18F-FDG uptake in patients with AAV was mainly gradeⅡwhich was similar to liver uptake(n=11,73.3%);LVV group was mainly gradeⅡ(n=8,53.3%)and gradeⅢwhich was higher than liver uptake(n=7,46.7%);and HC group was mainly gradeⅠwhich was lower than the level of liver uptake(n=9,90%).The TBRmax of the most diseased segment was significantly higher compared to HC(1.51±0.24)in AAV patients(2.63±1.53)(P=0.040<0.05)and LVV patients(3.08±1.65)(P=0.007<0.05);LVV group was tend to be higher than that of AAV group,but this did not reach statistical significance(P=0.820>0.05).The mean TBRmax was significantly higher in patients suffering from AAV(1.99±0.42)or LVV(2.43±0.99)compared to HC(1.39±0.20)(P=0.000<0.05,P=0.003<0.05,respectively);and LVV group was higher than that of AAV group,but this did not reach statistical significance(P=0.328>0.05).Conclusion Patients suffering from AAV show marked aortic FDG uptake,which may suggesting that large vessel involvement in patients with small vessel vasculitis.18F-FDG PET/CT has a unique advantage over the comprehensive evaluation of patients suffering from AAV.