超声检查和正电子发射断层扫描在大血管血管炎诊断和评估中的应用。
Use of ultrasonography and positron emission tomography in the diagnosis and assessment of large-vessel vasculitis.
作者信息
Schmidt Wolfgang A, Blockmans Daniel
机构信息
Medical Center for Rheumatology Berlin-Buch, Germany.
出版信息
Curr Opin Rheumatol. 2005 Jan;17(1):9-15. doi: 10.1097/01.bor.0000147282.02411.c6.
PURPOSE OF REVIEW
Ultrasonography and positron emission tomography have been increasingly studied and, in part, introduced in clinical practice to diagnose large-vessel vasculitides, such as temporal arteritis, Takayasu arteritis, large-vessel giant cell arteritis, and isolated aortitis.
RECENT FINDINGS
Ultrasonography reveals characteristic homogenous, concentric wall thickening in vasculitis, often combined with stenoses and, less frequently, with acute occlusions. Thirteen studies describe sensitivities of 40 to 100% (median, 86%) for temporal artery vessel wall edema compared with histology, and of 35 to 86% (median, 70%) compared with clinical diagnosis. If wall edema, stenoses, and occlusions are included, sensitivities increase to 91 to 100% (median, 95%) compared with histology, and to 83 to 100% (median, 88%) compared with clinical diagnosis. Specificities for wall edema are 68 to 100% (median, 93%) compared with histology, and 78 to 100% (median, 97%) compared with clinical diagnosis. One should be aware of large-vessel giant cell arteritis in all patients with temporal arteritis and polymyalgia rheumatica. Ultrasonography reveals characteristic wall thickening, particularly of the distal subclavian, axillary, and proximal brachial arteries. Findings in Takayasu arteritis are similar, but the vessel wall swelling is usually brighter. Positron emission tomography reveals vasculitis in arteries with a diameter of more than 4 mm. Ultrasonography and positron emission tomography agreed completely in the anatomic distribution of changes in patients with large-vessel giant cell arteritis. It reveals asymptomatic large-vessel vasculitis in giant cell arteritis and Takayasu arteritis. Positron emission tomography is not suitable for the assessment of temporal arteries.
SUMMARY
Ultrasonography and positron emission tomography are new, promising techniques to assess large-vessel vasculitides.
综述目的
超声检查和正电子发射断层扫描已得到越来越多的研究，并部分引入临床实践以诊断大血管血管炎，如颞动脉炎、高安动脉炎、大血管巨细胞动脉炎和孤立性主动脉炎。
最新发现
超声检查显示血管炎中特征性的均匀、同心性管壁增厚，常伴有狭窄，较少见急性闭塞。13项研究描述了与组织学相比，颞动脉血管壁水肿的敏感度为40%至100%（中位数为86%），与临床诊断相比为35%至86%（中位数为70%）。若将管壁水肿、狭窄和闭塞纳入考量，与组织学相比，敏感度增至91%至100%（中位数为95%），与临床诊断相比增至83%至100%（中位数为88%）。与组织学相比，管壁水肿的特异度为68%至100%（中位数为93%），与临床诊断相比为78%至100%（中位数为97%）。所有患有颞动脉炎和风湿性多肌痛的患者均应警惕大血管巨细胞动脉炎。超声检查显示特征性的管壁增厚，尤其是锁骨下动脉远端、腋动脉和肱动脉近端。高安动脉炎的表现相似，但血管壁肿胀通常更明显。正电子发射断层扫描可显示直径大于4mm的动脉中的血管炎。在大血管巨细胞动脉炎患者中，超声检查和正电子发射断层扫描在病变的解剖分布上完全一致。它可揭示巨细胞动脉炎和高安动脉炎中无症状的大血管血管炎。正电子发射断层扫描不适用于颞动脉的评估。
总结
超声检查和正电子发射断层扫描是评估大血管血管炎的有前景的新技术。
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