Publication: Utilidad del PET-TC en la valoración del crecimiento del aneurisma de aorta abdominal y su relación con los cambios en el metabolismo energético
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2018-03-19
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Universidad Complutense de Madrid
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Abstract
Los aneurismas de aorta abdominal (AAA) constituyen una grave patología cuya rotura conlleva una elevada mortalidad. En la evolución de los AAA el crecimiento inicial suele ser lento y progresivo, pero posteriormente puede acelerarse y llegar a la rotura. Actualmente el diámetro del aneurisma es el factor más determinante para valorar el riesgo de rotura, por lo que en los AAA de pequeño tamaño el manejo suele ser conservador, aunque se ha demostrado que también pueden llegar a la fatal complicación. En el momento actual se desconoce por qué unos AAA desarrollan un crecimiento más rápido, si bien parece haberse demostrado que éstos presentan una mayor actividad inflamatoria en su pared. Sin embargo, se desconocen cuáles son los factores implicados en ese incremento de actividad metabólica, dentro de los diferentes procesos implicados en el metabolismo energético (metabolismo aerobio y anaerobio de la glucosa, beta-oxidación de ácidos grasos, fosforilación oxidativa). El PET-TC es un método diagnóstico habitualmente utilizado en patología oncológica buscando zonas de hipercaptación tumoral. El substrato más habitual es el 18-fluorodeoxiglucosa (18-FDG), muy útil para detectar actividad tumoral pero también para actividad inflamatoria. Diversos autores han demostrado que existe una mayor captación de 18-FDG mediante el PETTC en la pared aneurismática en determinados pacientes, lo que implica un incremento de actividad metabólica asociada a una elevada densidad de células inflamatorias en la pared, conllevando un mayor riesgo de expansión y rotura. Aunque otros autores dudan de esta correlación, la captación de 18FDG mediante el PET-TC en los AAA se postula como un posible biomarcador de crecimiento de los AAA...
The abdominal aortic aneurysm (AAA) is a severe pathology, which rupture is associated with a high mortality. In the early evolution the growth rate is usually slow and progressive, but later it can accelerate and lead to rupture. Actually the diameter of the aneurysm is the most important factor to consider the risk of rupture, so conservative management is preferred for small aneurysms, although they can also lead to the fatal complication. It remains unknown why some AAA develop a faster growth, but an increased inflammatory activity in the aortic wall has been demonstrated in these cases. However, the factors involved in that increased metabolic activity remain unknown, about the different processes involved in the energetic metabolism (aerobic and anaerobic metabolism of glucose, beta-oxidation of fatty acids, oxidative phosphorylation) PET-CT is a diagnostic method usually employed in neoplastic pathology to find areas of malignant cells uptake. The most widely applied substrate is the 18-fluorodeoxyglucose (18-FDG), very useful to detect tumoral activity but inflammatory activity too. It’s been demostrated that in some cases there is an increased 18-FDG uptake by PET-CT in the aneurysmal wall, related to an increased metabolic activity associated to a high density of inflammatory cells in the wall, leading to a higher risk of expansion and rupture. Although another authors don’t agree about this correlation, 18-FDG uptake by PET-CT is presented as a possible biomarker in the AAA growth...
The abdominal aortic aneurysm (AAA) is a severe pathology, which rupture is associated with a high mortality. In the early evolution the growth rate is usually slow and progressive, but later it can accelerate and lead to rupture. Actually the diameter of the aneurysm is the most important factor to consider the risk of rupture, so conservative management is preferred for small aneurysms, although they can also lead to the fatal complication. It remains unknown why some AAA develop a faster growth, but an increased inflammatory activity in the aortic wall has been demonstrated in these cases. However, the factors involved in that increased metabolic activity remain unknown, about the different processes involved in the energetic metabolism (aerobic and anaerobic metabolism of glucose, beta-oxidation of fatty acids, oxidative phosphorylation) PET-CT is a diagnostic method usually employed in neoplastic pathology to find areas of malignant cells uptake. The most widely applied substrate is the 18-fluorodeoxyglucose (18-FDG), very useful to detect tumoral activity but inflammatory activity too. It’s been demostrated that in some cases there is an increased 18-FDG uptake by PET-CT in the aneurysmal wall, related to an increased metabolic activity associated to a high density of inflammatory cells in the wall, leading to a higher risk of expansion and rupture. Although another authors don’t agree about this correlation, 18-FDG uptake by PET-CT is presented as a possible biomarker in the AAA growth...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 22/02/2017