Berger Christoph T, Sommer Gregor, Aschwanden Markus, Staub Daniel, Rottenburger Christof, Daikeler Thomas
Translational Immunology and Medical Outpatient Clinic, Departments of Biomedicine and Internal Medicine, University Basel and University Hospital Basel, Switzerland.
Department of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland.
Swiss Med Wkly. 2018 Aug 22;148:w14661. doi: 10.4414/smw.2018.14661. eCollection 2018 Aug 13.
Historically, giant cell arteritis (GCA) was considered to be synonymous with temporal arteritis. However, the disease spectrum of GCA extends much further, and includes vasculitis of the aorta and its branches with or without involvement of the temporal arteries. Imaging is crucial for the diagnosis and follow-up of GCA patients. Large vessel GCA (LV-GCA) often presents as an inflammatory syndrome and is only detected by imaging modalities such as: colour duplex sonography (CDS), computed tomography (CT) / CT angiography (CTA), magnetic resonance imaging (MRI) or 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) / CT. Deciding which imaging modality to use in different clinical situations remains a matter of debate. CDS and MRI enable assessment of the temporal arteries with a presumably higher sensitivity than histology. In the context of a typical presentation, CDS can replace a biopsy. In about a third of patients, the temporal arteries are not involved, thus PET/CT, MRI, CT, or CDS of larger arteries is needed to diagnose GCA. The sensitivity of all modalities is affected by glucocorticoid therapy. Therefore, without delaying therapy, imaging should be performed within a few days of treatment initiation. The use of PET/CT for the work-up of inflammatory syndromes in the elderly reveals vasculitis in approximately 20% of examined patients and uncover relevant diagnoses in the majority of remaining patients. The aorta should be routinely assessed in all GCA patients at diagnosis and during follow-up. MRA or CTA are best suited to characterise structural damage of larger arteries. The role of imaging in monitoring GCA disease activity still needs to be further defined.
从历史上看，巨细胞动脉炎（GCA）被认为与颞动脉炎同义。然而，GCA的疾病谱范围更广，包括主动脉及其分支的血管炎，可伴有或不伴有颞动脉受累。影像学检查对于GCA患者的诊断和随访至关重要。大血管GCA（LV-GCA）通常表现为一种炎症综合征，仅通过诸如彩色双功超声（CDS）、计算机断层扫描（CT）/CT血管造影（CTA）、磁共振成像（MRI）或18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）/CT等影像学手段才能检测到。决定在不同临床情况下使用哪种影像学手段仍存在争议。CDS和MRI对颞动脉的评估可能比组织学检查具有更高的敏感性。在典型表现的情况下，CDS可替代活检。约三分之一的患者颞动脉未受累，因此需要对较大动脉进行PET/CT、MRI、CT或CDS检查以诊断GCA。所有检查手段的敏感性都会受到糖皮质激素治疗的影响。因此，在不延误治疗的情况下，应在开始治疗后的几天内进行影像学检查。使用PET/CT对老年人的炎症综合征进行检查时，约20%的受检患者可发现血管炎，大多数其余患者可发现相关诊断。在所有GCA患者诊断时和随访期间都应常规评估主动脉。MRA或CTA最适合于描述较大动脉的结构损伤。影像学在监测GCA疾病活动中的作用仍需进一步明确。
