Mekinian A, Djelbani S, Viry F, Fain O, Soussan M
Service de médecine interne, département inflammation-immunopathologie biothérapie (DHU i2B), hôpital Saint-Antoine, AP-HP, Sorbonne universités, UPMC université Paris 6, 75012 Paris, France.
Service de médecine nucléaire, hôpital Avicenne, AP-HP, Paris Sorbonne Cité, UPMC université Paris 13, 93000 Bobigny, France.
Rev Med Interne. 2016 Apr;37(4):245-55. doi: 10.1016/j.revmed.2015.10.353. Epub 2016 Feb 12.
The imaging is essential for the diagnosis of large vessels arteritis, in order to assess the persistent inflammation of arterial lesions, to evaluate the treatment response and search the vascular complications. In patients with giant cell arteritis (GCA), the aortitis could be suspected in 2 situations: in the presence of general constitutional symptoms or systematic screening of aortitis in patient with confirmed GCA. The frequency of aortitis varies according to the imaging method and could be detected in 40 % of patients with computed tomography and MRI, and approximately in 60 % with FDG-PET/CT. The clinical and prognostic value of systematic detection of aortitis during the GCA remains to be determined. In Takayasu arteritis, imaging is performed to diagnose the large vessels vasculitis, to determine the arterial lesions extension to assess the persistent inflammation of arterial lesions. The persistent vascular inflammation should be suspected in the presence of arterial thickness, of arterial enhancement, a parietal edema and increased arterial FDG uptake (>liver). However, the value of these parameters and the threshold remain to be determined. Thus, the value of FDG-PET/CT and MRI and of parameters used to characterize the persistent arterial inflammation should be further studied.
影像学检查对于大动脉炎的诊断至关重要，目的是评估动脉病变的持续炎症、评估治疗反应以及查找血管并发症。在巨细胞动脉炎（GCA）患者中，有两种情况可能怀疑存在主动脉炎：出现全身症状时，或对确诊GCA的患者进行主动脉炎的系统筛查时。主动脉炎的发生率因影像学检查方法而异，在40%的计算机断层扫描和磁共振成像患者中可检测到，而在氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）检查中约为60%。GCA期间主动脉炎系统检测的临床和预后价值仍有待确定。在高安动脉炎中，进行影像学检查以诊断大血管血管炎，确定动脉病变范围，评估动脉病变的持续炎症。当出现动脉增厚、动脉强化、壁层水肿以及动脉FDG摄取增加（>肝脏）时，应怀疑存在持续性血管炎症。然而，这些参数的价值和阈值仍有待确定。因此，应进一步研究FDG-PET/CT和磁共振成像以及用于表征持续性动脉炎症的参数的价值。
