Scientific letter
Usefulness of the PET/CT scan in the diagnosis of short-segment Takayasu arteritis
Utilidad de la PET/TAC en el diagnóstico de la arteritis de Takayasu de segmento corto
Rocío Pastor Martíneza,
, Miguel Gallardo Padillab, Lorena Patricia Peña Gonzálezb, Adolfo Gómez Grandec, Jaime de Inocencio Arocenad,e
Corresponding author
a Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, Spain
b Servicio de Pediatría, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
c Servicio de Medicina Nuclear, Hospital Universitario 12 de Octubre, Madrid, Spain
d Unidad de Reumatología Pediátrica, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, Spain
e Departamento de Pediatría, Universidad Complutense de Madrid, Madrid, Spain
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class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Usefulness of the PET/CT scan in the diagnosis of short-segment Takayasu arteritis" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "55" "paginaFinal" => "57" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rocío Pastor Martínez, Miguel Gallardo Padilla, Lorena Patricia Peña González, Adolfo Gómez Grande, Jaime de Inocencio Arocena" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Rocío" "apellidos" => "Pastor Martínez" "email" => array:1 [ 0 => "rociopmartinez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Miguel" "apellidos" => "Gallardo Padilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Lorena Patricia" "apellidos" => "Peña González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Adolfo" "apellidos" => "Gómez Grande" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Jaime" "apellidos" => "de Inocencio Arocena" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Unidad de Reumatología Pediátrica, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Pediatría, Universidad Complutense de Madrid, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la PET/TAC en el diagnóstico de la arteritis de Takayasu de segmento corto" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1052 "Ancho" => 1733 "Tamanyo" => 153029 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET/CT and CT images. (A) Sagittal PET/CT and CT views showing increased tracer uptake in the walls of the thoracic aorta (red arrows) and superior mesenteric artery (yellow arrow). (B) Axial PET/CT and CT views showing increased uptake in the walls of the superior mesenteric artery with a SUVmax of 4.03 (yellow arrows). (C) Axial CT view showing thinning of the walls of the proximal segment of the superior mesenteric artery (yellow arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Takayasu arteritis is a chronic inflammatory and granulomatous vasculitis of autoimmune aetiology that affects the large vessels and may lead to the development of stenosis, occlusion or aneurisms.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Its incidence is of 1.2–2.6 cases per million inhabitants,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> and it therefore may be the third most frequent vasculitis in the paediatric age group following Henoch-Schönlein purpura and Kawasaki disease. It usually has onset in adulthood, with its incidence peaking between ages 25 and 30 years.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a patient with atypical features of this disease, including her young age, the short time elapsed between onset and diagnosis, the short length of the aortic segment involved and the diagnosis during the inflammatory phase, emphasising the considerable usefulness of positron emission tomography/computed tomography (PET/CT), which allowed an early diagnosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a girl aged 5 years with no relevant history that was brought to the emergency department with intermittent but intense periumbilical abdominal pain of 2 weeks’ duration, associated with fever of up to 38<span class="elsevierStyleHsp" style=""></span>°C with no additional symptoms. Her vital signs, including the blood pressure in all 4 extremities, and the general examination were normal. The examination did not detect cardiac or abdominal murmurs and the carotid, axillary, antecubital, inguinal and popliteal pulses were all normal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The blood tests revealed microcytic anaemia (haemoglobin, 10<span class="elsevierStyleHsp" style=""></span>g/dL; mean corpuscular volume, 68) with leucocytosis (13<span class="elsevierStyleHsp" style=""></span>000/mm<span class="elsevierStyleSup">3</span>, 74% neutrophils) and an elevated serum C-reactive protein (CRP) level of 18.4<span class="elsevierStyleHsp" style=""></span>mg/dL, while the liver and kidney function tests were normal. The findings of a throat swab culture, urinalysis, chest radiograph and abdominal ultrasound examination were normal. Since the symptoms persisted and the elevation of CRP increased (to a maximum of 32<span class="elsevierStyleHsp" style=""></span>mg/dL), a computed tomography (CT) scan was performed that revealed periaortic wall thickening between the exit of the celiac trunk and the proximal third of the superior mesenteric artery (SMA) compatible with periaortitis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), which led to referral to our hospital.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Samples were obtained for blood and stool culture, serologic tests (syphilis, cytomegalovirus, <span class="elsevierStyleItalic">Mycoplasma</span>, parvovirus), Mantoux, autoimmunity study (antinuclear [ANA] and extractable nuclear antigen [ENA], anti-proteinase 3 [PR3] and anti-myeloperoxidase [MPO] antibodies, rheumatoid factor), quantification of levels immunoglobulins—including IgG4—and complement levels, all with normal or negative results. The findings of the cardiac and ophthalmological evaluations were normal. An abdominal doppler ultrasound examination confirmed the findings of the CT scan; and the findings of an ultrasound scan of the supra-aortic trunks were normal. Given the small extension of the periaortitis and the absence of stenosis, a PET/CT scan was ordered, which revealed patchy deposits in the wall of the thoracic descending aorta with a maximum standardised uptake (SUVmax) of 4.11 and diffuse enlargement of 2.3<span class="elsevierStyleHsp" style=""></span>cm in the abdominal aorta with a SUVmax of 4.03, suggestive of vascular inflammation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient received a diagnosis of Takayasu arteritis type III. The initial treatment consisted of steroids, first delivered intravenously and after by the oral route, and methotrexate, and achieved rapid resolution of the pain and a reduction in the serum levels of CRP. At one month, given the persistence of CRP elevation, the patient started treatment with infliximab, with a very good response. At present (age 7 years), the patient is asymptomatic and serial Doppler ultrasound examinations have demonstrated the resolution of aortic thickening, while the findings of follow-up MR angiography and CPR tests have been normal.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The course of Takayasu arteritis is divided into 2 phases. The initial inflammatory phase is characterised by intermittent nonspecific symptoms (fever, anorexia, night sweats, weight loss) and may last months or even years. It is followed by an occlusive phase, which manifests with headache, ischaemic strokes, hypertension or intermittent claudication in the upper or lower extremities, among other symptoms. The nonspecificity of the initial symptoms accounts for the mean delay in diagnosis of 11 months reported for the paediatric age group.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> In children, the most commonly involved sites are the renal arteries and the abdominal aorta.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In 2010, new criteria were published for the classification (not for diagnosis) of several paediatric vasculitis, including Takayasu arteritis (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Although it has been classically diagnosed by means of angiography, PET/CT has demonstrated a high sensitivity and specificity,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> especially in patients that have not reached the occlusive phase or with involvement of a small aortic segment, as was the case in our patient. Magnetic resonance angiography is very useful, but it poses some challenges in paediatric patients (higher heart rates; smaller volumes of contrast, as the dose is based on weight; breathing movements during sedation),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> especially in cases without occlusion; it offers a high resolution for the definition of anatomical structures, but provides little information on inflammatory activity.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The treatment is based on the administration of corticosteroids, immunosuppressive agents (methotrexate, azathioprine) and biological agents (anti-TNF or, more recently, anti-IL6).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The diagnosis of Takayasu arteritis should be contemplated in patients with prolonged or recurrent fever, intermittent abdominal pain, hypertension or focal neurologic signs associated with an unexplained elevation of acute-phase reactants. Early diagnosis allows prompt initiation of treatment and can prevent the progression of the disease to an irreversible stage.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:3 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pastor Martínez R, Gallardo Padilla M, Peña González LP, Gómez Grande A, de Inocencio Arocena J. Utilidad de la PET/TAC en el diagnóstico de la arteritis de Takayasu de segmento corto. An Pediatr (Barc). 2019;91:55–57.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Previous presentation in congresses.</p>" ] 2 => array:2 [ "etiqueta" => "☆☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015"><span class="elsevierStyleBold">Previous presentation:</span> This study was presented as a poster at the 65 Congress of the Asociación Española de Pediatría; June 1–3, 2017; Santiago de Compostela, Spain.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1052 "Ancho" => 1733 "Tamanyo" => 153029 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET/CT and CT images. (A) Sagittal PET/CT and CT views showing increased tracer uptake in the walls of the thoracic aorta (red arrows) and superior mesenteric artery (yellow arrow). (B) Axial PET/CT and CT views showing increased uptake in the walls of the superior mesenteric artery with a SUVmax of 4.03 (yellow arrows). (C) Axial CT view showing thinning of the walls of the proximal segment of the superior mesenteric artery (yellow arrow).</p>" ] ] 1 => array:9 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Ozen et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Requires meeting the mandatory criterion and at least 1 additional criterion.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mandatory criterion \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Additional criteria \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Angiographic abnormality detected by angiography (conventional, CT, or MRI) of the aorta or its main branches and pulmonary arteries showing aneurysm/dilatation, narrowing, occlusion or thickened arterial wall; these changes are usually focal or segmental</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lost/decreased peripheral artery pulse and/or claudication in limbs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discrepancy of four limb systolic blood pressure >10<span class="elsevierStyleHsp" style=""></span>mm Hg difference in any limb \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Audible murmurs or palpable thrills over large arteries \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial hypertension (Systolic/diastolic BP greater than 95th centile for height) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elevation of acute phase reactants (erythrocyte sedimentation rate<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mm or CRP above the reference value applied in the laboratory) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2074244.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Criteria for classification of Takayasu arteritis proposed by the European League Against Rheumatism (EULAR), the Paediatric Rheumatology International Trials Organisation (PRINTO) and the Paediatric Rheumatology European Society (PRES).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takayasu arteritis in childhood: retrospective experience from a tertiary referral centre in the United Kingdom" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Eleftheriou" 1 => "G. Varnier" 2 => "P. Dolezalova" 3 => "A.M. McMahon" 4 => "M. Al-Obaidi" 5 => "P.A. Brogan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13075-015-0545-1" "Revista" => array:5 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25879697" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New TA features: age and sex specificity observed from cross-country research in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. Watanabe" 1 => "T. Miyata" 2 => "K. Tanemoto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2015" "volumen" => "132" "paginaInicial" => "1701" "paginaFinal" => "1709" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood Takayasu arteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Goel" 1 => "T.S. Kumar" 2 => "D. Danda" 3 => "G. Joseph" 4 => "V. Jeyaseelan" 5 => "A.K. Surin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Rheumatol" "fecha" => "2014" "volumen" => "41" "paginaInicial" => "1183" "paginaFinal" => "1189" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener's granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: final classification criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Ozen" 1 => "A. Pistorio" 2 => "S.M. Iusan" 3 => "A. Bakkaloglu" 4 => "T. Herlin" 5 => "R. Brik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2009.116657" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2010" "volumen" => "69" "paginaInicial" => "798" "paginaFinal" => "806" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20413568" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI and the PET Interest Group (PIG), and endorsed by the ASNC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.H.J.A. Slart" 1 => "A.W.J.M. Glaudemans" 2 => "P. Chareonthaitawee" 3 => "G. Treglia" 4 => "F.L. Besson" 5 => "T.A. 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| Year/Month | Html | Total | |
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| 2024 November | 4 | 5 | 9 |
| 2024 October | 37 | 34 | 71 |
| 2024 September | 54 | 30 | 84 |
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| 2024 February | 47 | 27 | 74 |
| 2024 January | 48 | 17 | 65 |
| 2023 December | 56 | 32 | 88 |
| 2023 November | 55 | 36 | 91 |
| 2023 October | 46 | 17 | 63 |
| 2023 September | 47 | 20 | 67 |
| 2023 August | 41 | 26 | 67 |
| 2023 July | 52 | 27 | 79 |
| 2023 June | 48 | 24 | 72 |
| 2023 May | 64 | 19 | 83 |
| 2023 April | 41 | 15 | 56 |
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| 2021 December | 56 | 39 | 95 |
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| 2021 October | 103 | 63 | 166 |
| 2021 September | 55 | 37 | 92 |
| 2021 August | 54 | 41 | 95 |
| 2021 July | 41 | 25 | 66 |
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| 2021 April | 124 | 50 | 174 |
| 2021 March | 98 | 34 | 132 |
| 2021 February | 57 | 12 | 69 |
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| 2020 December | 71 | 24 | 95 |
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| 2020 October | 60 | 16 | 76 |
| 2020 September | 47 | 15 | 62 |
| 2020 August | 64 | 4 | 68 |
| 2020 July | 60 | 15 | 75 |
| 2020 June | 51 | 3 | 54 |
| 2020 May | 58 | 14 | 72 |
| 2020 April | 27 | 10 | 37 |
| 2020 March | 35 | 14 | 49 |
| 2020 February | 55 | 13 | 68 |
| 2020 January | 52 | 8 | 60 |
| 2019 December | 72 | 26 | 98 |
| 2019 November | 38 | 9 | 47 |
| 2019 October | 49 | 12 | 61 |
| 2019 September | 42 | 13 | 55 |
| 2019 August | 33 | 10 | 43 |
| 2019 July | 64 | 25 | 89 |
| 2019 June | 123 | 15 | 138 |
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