PMC8034796_01
Whole-body maximum intensity projection image (a) shows fluorodeoxyglucose uptake in both iliofemoral (blue arrow) and tibioperoneal (red arrows) and vertebral (green arrow) arteries. Subclavian and axillary arteries show fluorodeoxyglucose uptake less than the liver (black arrow). There is fluorodeoxyglucose-avid synovitis (dotted green arrow) and periarticular uptake (dotted black arrows) suggestive of polymyalgia rheumatica. Axial-fused positron emission tomography/ computed tomography images show increased fluorodeoxyglucose uptake in femoral (white arrows, b), anterior tibial (white arrow, c), posterior tibial (solid yellow arrow, c), and peroneal (dotted yellow arrow, c) arteries and periarticular and synovial uptake in hip joints (white arrow, d)
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F1
Due to lack of response to steroids, 18F-fluorodeoxyglucose (FDG) PET/CT was performed from vertex to toes on a digital PET/CT scanner (DMI , GE Healthcare, Milwaukee, Wisconsin, USA) to evaluate for underlying vasculitis [Figures 1 and 2]. The FDG PET/CT showed intense FDG uptake greater than the liver in bilateral lower extremity arteries and their branches, including iliofemoral and tibioperoneal arteries [Figure 1]. FDG PET/CT also showed synovitis and inflammatory type uptake around large joints of the appendicular skeleton, suggestive of PMR [Figure 1].
Coronal positron emission tomography only images anteriorly (a) and posteriorly (b) and axial-fused positron emission tomography/computed tomography images of the neck (c) and head (d) show increased fluorodeoxyglucose uptake in external carotid arteries (solid black arrow, a), bilateral superficial temporal arteries (pink arrows, a and c), and vertebral arteries (green arrows, b and d). The aorta is normal with fluorodeoxyglucose uptake within the range of normal for a modern silicon photomultiplier digital positron emission tomography scanner (dotted black arrow, e)
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F2
Due to lack of response to steroids, 18F-fluorodeoxyglucose (FDG) PET/CT was performed from vertex to toes on a digital PET/CT scanner (DMI , GE Healthcare, Milwaukee, Wisconsin, USA) to evaluate for underlying vasculitis [Figures 1 and 2]. Increased uptake was also seen in extracranial head-and-neck arteries including vertebral, carotid, and superficial temporal arteries [Figure 2]. The aorta was normal [Figure 2].