Department of Radiology, School of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
J Clin Rheumatol. 2011 Sep;17(6):306-10. doi: 10.1097/RHU.0b013e31822acec6.
Noninvasive diagnosis of giant cell arteritis (GCA) remains challenging, particularly with regard to evaluation of extracranial arterial disease.
The objective of the study was to retrospectively review extracranial involvement in patients with GCA and/or polymyalgia rheumatica (PMR), evaluated with magnetic resonance imaging (MRI), especially 3-dimensional contrast-enhanced magnetic resonance angiography images of the aortic arch and its branches.
Clinical information, biopsy status, and MRI examinations of 28 patients with GCA/PMR were reviewed. Patient images were mixed randomly with 20 normal control images and were independently reviewed by 2 radiologists. Interobserver agreement for detection of arterial stenosis was determined by the k coefficient.
Both readers described vascular alterations in keeping with extracranial GCA in 19 of 28 patients (67%) with good interobserver agreement (k = 0.73) and with even higher agreement on diagnosing nonocclusive versus occlusive disease (k = 1.00). The most common lesions were bilateral axillary stenosis or obstructions, observed by both readers in 8 patients (28%). Among the 19 patients with magnetic resonance angiography lesions in the subclavian/axillary arteries, 12 (75%) had biopsy-proven GCA, but only 5 (41%) of these patients had clinical features of large artery disease.
In our series review, MRI could provide accurate information on involvement of the aortic arch and its branches in extracranial GCA, depicting different degrees of stenosis. Our analysis also illustrates that occult large artery vasculitis should be considered in patients without biopsy-proven GCA, patients with classic GCA but without clinical signs of large artery disease, and in patients initially diagnosed as having PMR.
巨细胞动脉炎（GCA）的无创诊断仍然具有挑战性，尤其是在评估颅外动脉疾病方面。
本研究旨在回顾性分析经磁共振成像（MRI）评估的 GCA 和/或多发性肌痛（PMR）患者的颅外受累情况，特别是主动脉弓及其分支的三维对比增强磁共振血管成像（3D-CE-MRA）图像。
回顾性分析了 28 例 GCA/PMR 患者的临床资料、活检情况和 MRI 检查结果。将患者的图像与 20 例正常对照图像随机混合，由 2 位放射科医生独立进行阅片。采用κ系数评估动脉狭窄检测的观察者间一致性。
两位观察者均在 28 例患者中的 19 例（67%）中描述了符合颅外 GCA 的血管改变，观察者间一致性良好（κ=0.73），对非闭塞性与闭塞性疾病的诊断一致性更高（κ=1.00）。最常见的病变是双侧腋动脉狭窄或闭塞，两位观察者均在 8 例患者（28%）中观察到。在 19 例锁骨下/腋动脉磁共振血管成像有病变的患者中，12 例（75%）有活检证实的 GCA，但这些患者中只有 5 例（41%）有大动脉疾病的临床特征。
在我们的回顾性研究中，MRI 可以提供有关颅外 GCA 主动脉弓及其分支受累的准确信息，显示不同程度的狭窄。我们的分析还表明，对于无活检证实的 GCA 但有隐匿性大动脉炎的患者、有典型 GCA 但无大动脉疾病临床特征的患者以及最初诊断为 PMR 的患者，应考虑隐匿性大动脉血管炎。
