Division of Vascular Medicine, Campus City Center, University Hospital Munich, Germany.
Clin Exp Rheumatol. 2010 Jul-Aug;28(4):549-52. Epub 2010 Aug 30.
To evaluate the clinical characteristics and imaging results (CDS, 18-FDG-PET) of patients with large vessel giant cell arteritis (LV-GCA) presenting as fever of unknown origin (FUO).
From a series of 82 patients with GCA we identified 8 patients with FUO as initial disease manifestation. Clinical characteristics and results of CDS and 18-FDG-PET were analysed. Patients with FUO and those with other clinical manifestations of GCA were compared.
18-FDG-PET-scans were available for 6/8 patients, revealing enhanced tracer uptake of the thoracic aorta and the aortic branches in all patients. CDS was performed in 8/8 patients, with detection of hypoechogenic wall thickening related to LV-GCA in 7/8 patients. Subjects with FUO were significantly younger (60.9 vs. 69.3 years, p<0.01) and had a stronger humoral inflammatory response (CRP 12.6 vs. 7.1 mg/dl, p<0.01; ESR 110 vs. 71 mm/hour, p<0.01), when compared to the other GCA-patients.
LV-GCA should be considered as important differential diagnosis in patients with FUO. In addition to 18-FDG-PET, which is known to be a valuable method in the diagnostic work-up of FUO, we recommend CDS of the supraaortal and femoropopliteal arteries for the initial diagnostic work-up.
评估以不明原因发热（FUO）为首发表现的巨细胞动脉炎（GCA）患者的临床特征和影像学结果（彩色多谱勒超声，18-FDG-PET）。
从一系列 82 例 GCA 患者中，我们确定了 8 例以 FUO 为首发表现的患者。分析了他们的临床特征、彩色多谱勒超声和 18-FDG-PET 的结果。并将 FUO 患者与其他 GCA 患者的临床表现进行了比较。
18-FDG-PET 扫描可用于 6/8 例患者，所有患者均显示胸主动脉和主动脉分支摄取示踪剂增强。8/8 例患者行彩色多谱勒超声检查，7/8 例患者发现与 LV-GCA 相关的低回声壁增厚。FUO 患者明显更年轻（60.9 岁 vs. 69.3 岁，p<0.01），且具有更强的体液炎症反应（CRP 12.6 毫克/分升 vs. 7.1 毫克/分升，p<0.01；ESR 110 毫米/小时 vs. 71 毫米/小时，p<0.01）。
LV-GCA 应作为 FUO 患者的重要鉴别诊断。除了已知对 FUO 诊断评估有价值的 18-FDG-PET 外，我们还建议对主动脉和股浅动脉进行彩色多谱勒超声检查作为初始诊断性评估。
