Pulmonary involvement in Behcet’s disease: Definition of Tc99m-MAA lung scintigraphy perfusion patterns according to the affected pulmonary vascular levels

Yıl 2020, Cilt: 37 Sayı: 2, 29 - 35, 06.04.2020

Sibel Uçak Semirgin , Oguz Uzun

Öz

The aim of this study was to define lung perfusion scintigraphy findings in Behcet’s disease (BD) patients with different variations of pulmonary involvement. Medical records and imaging findings of 23 patients with pulmonary involvement of BD were retrospectively reviewed. Before scintigraphic evaluation, patients were classified according to the affected pulmonary vascular level on CT angiography (CTA) as follows: Macroscopic pulmonary vascular involvement (Gr-1) [Pulmonary artery aneurysm without thrombosis (Gr-1a), pulmonary artery aneurysm with thrombosis (Gr-1b), pulmonary artery thrombosis without aneurysm (Gr-1c)]; microscopic pulmonary vascular involvement (Gr-2; no macroscopic CTA findings but with clinical diagnosis and/or scintigraphic abnormality). There were 18 patients in Gr-1 and five patients in Gr-2. Segmental/subsegmental perfusion defects were the most common perfusion pattern and no distinctive pattern was observed among all groups. In 12 patients with macroscopic disease and two patients with microscopic disease, perfusion defects were more extensive than involved vessels on CTA and/or also in the contralateral lung. There were 13 patients with scintigraphic follow-up findings. No change was observed in all Gr-1b and Gr-2 patients; there were heterogeneous changes in 6/7 patients in Gr-1c. No typical perfusion pattern could be demonstrated for a given macroscopic vascular category. In patients with microscopic disease, similarly no characteristic pattern could be defined. As almost all patients with microscopic disease showed perfusion anomalies, scintigraphy may be proposed as a first step examination in case of suspected pulmonary involvement in BD. Scintigraphic follow-up may be of value in pure thrombotic pulmonary involvement.

Anahtar Kelimeler

Behcet’s disease, lung perfusion, scintigraphy, CT angiography

Kaynakça

• Akpolat, T., Akkoyunlu, M., Akpolat ,I., Dilek, M., Odabas, A.R., Ozen, S., 2002. Renal Behcet’s disease: a cumulative analysis. Semin Arthritis Rheum. 31,317-337.
• Behcet, H., 1937. Uber rezidivierende aphthose, durch ein virus verursachte Geschwure am Mund, am Auge und an den Genitalien. Dermatol Woschenschr. 105,1152-1157.
• Caglar, M., Ergun, E., Emri, S., 2000. 99Tcm-MAA lung scintigraphy in patients with Behçet's disease: its value and correlation with clinical course and other diagnostic modalities. Nucl Med Commun. 21,171-179.
• Denecke, T., Staeck, O., Amthauer, H., Hänninen, E.L., 2007. PET/CT visualises inflammatory activity of pulmonary artery aneurysms in Behçet disease. Eur J Nucl Med Mol Imaging. 34,970.
• Duzgun, N., Anil, C., Ozer, F., Acican, T., 2002. The disappearance of pulmonary artery aneurysms and intracardiac thrombus with immunosuppressive treatment in a patient with Behcet’s disease. Clin Exp Rheumatol. 20,56-57.
• Erkan, F., Gül, A., Tasali, E., 2001. Pulmonary manifestations of Behçet's disease. Thorax. 56,572-578.
• Gumuser , F.G., Pirildar, T., Batok, D., Sakar, A., Ruksen, E., Sayit, E., 2008. Assessment of alveolar epithelial permeability in Behçet's disease with 99mTc-DTPA aerosol scintigraphy. Ann Nucl Med. 22,349-355.
• Gumuser, G., Pırıldar, T., Tarhan, S., Batok, D., Ruksen, E., Sakar, A., Sayit, E., 2011.Technetium-99m-hexamethylpropylene amine oxime lung scintigraphy findings in patients with Behçet's disease. Nucl Med Commun. 32,363-368.
• Hamuryudan, V., Er, T., Seyahi, S., Akman, C., Tüzün, H., Fresko, I., Yurdakul, S., Numan, F., Yazici, H., 2004. Pulmonary Artery Aneurysm in Behçet Syndrome. AMJ.117, 867-870. International Study Group for Behçet’s disease,1990. Criteria for diagnosis of Behçet’s disease. Lancet. 335,1078-1080.
• Koç, Y., Güllü, I., Akpek,G., Akpolat, T., Kansu, E., Kiraz, S., Batman, F., Kansu, T., Balkanci, F., Akkaya, S., 1992. Vascular involvement in Behcet‘s disease. J Rheumatol. 19,402-410.
• Trad, S., Bensimhon, L., Hajjam ,M.E., Chinet ,T., Wechsler , B., Saadoun, D., 2013. 18F-fluorodeoxyglucose-positron emission tomography scanning is a useful tool for therapy evaluation of arterial aneurysm in Behçet's disease. Joint Bone Spine. 80,420-423.
• Unlu, M., Akıcıoglu, C., Yamac, K., Onder, M., 2001. Pulmonary involvement in Behçet's disease: evaluation of 123 I-MIBG retention. Nucl Med Commun. 22,1083-1088.
• Uzun, O., Akpolat, T., Erkan, L., 2005. Pulmonary vasculitis in Behcet disease: a cumulative analysis. Chest. 127,2243-2253.
• Uzun, O., Erkan, L., Akpolat, I., Findik, S., Atıcı, A.G., Akpolat, T., 2008. Pulmonary Involvement in Behçet’s Disease. Respiration. 75,310-321.
• Uzun, O., 2011. Pulmonary Involvement in Behçet’s Disease and Takayasu’s arteritis. Eur Respir Mon. 54,32-45.