Positron Emission Tomography in Takayasu Arteritis: A Review Including Patterns of Vascular Involvement Across Modalities and Regions

Abstract

Takayasu arteritis (TAK) is a rare, chronic large-vessel vasculitis that predominantly affects the aorta and its major branches. Early and accurate diagnosis remains essential to prevent irreversible vascular damage and organ dysfunction. Positron emission tomography/computed tomography (PET/CT) has emerged as a valuable imaging modality for detecting active vascular inflammation in TAK. Using 18F-fluorodeoxyglucose (18F-FDG), PET/CT enables the assessment of metabolic activity in inflamed arterial walls, supporting both initial diagnosis and disease monitoring. Compared with conventional imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT), PET/CT provides functional data correlated with inflammatory activity rather than solely anatomical changes. Recent studies have highlighted its utility in distinguishing active from chronic disease, predicting relapse, and evaluating treatment response. This review summarizes the role of PET/CT in TAK, addressing its advantages, patterns of vascular involvement, limitations, and future perspectives. Vascular lesions identified using PET/CT do not always align with those detected by other imaging modalities, with PET/CT demonstrating superiority in revealing aortic inflammation potentially overlooked by alternative techniques. Further research is needed to establish whether PET/CT-based vascular involvement patterns, rather than conventional angiographic findings, can help identify disease subtypes of TAK.

Keywords: Takayasu arteritis; computed tomography; imaging; positron emission tomography; vasculitis.

Figure 1

The frequency of arterial territory in Takayasu arteritis detected by several modalities in the literature is summarized as a heat map. Values are presented as percentages (%), with darker red indicating higher values. Abbreviations: CA, conventional angiography; CT, computed tomography; MRI, magnetic resonance imaging; PET, positron emission tomography; US, ultrasound.