Department of Internal Medicine, Division of Vascular Medicine.
Department of Rheumatology and Clinical Immunology.
Rheumatology (Oxford). 2020 Dec 1;59(12):3676-3684. doi: 10.1093/rheumatology/keaa102.
To compare colour duplex ultrasonography (CDU) findings with axillary 18F-fluorodeoxyglucose (FDG) PET/CT findings and to compare the diagnostic performance of temporal and axillary artery CDU with temporal artery CDU alone.
Patients suspected of GCA were retrospectively included. Presence of a halo or occlusion was considered a positive CDU finding. FDG-PET/CT-assessed axillary artery involvement was defined as axillary artery FDG uptake higher than liver uptake. The reference was the clinical diagnosis after 6 months, which was based on symptomatology and additional diagnostic tests, with the exception of CDU.
Of the 113 included patients, GCA was diagnosed in 41. Twenty-eight out of 41 GCA patients underwent a FDG-PET/CT. FDG-PET-assessed extra-cranial GCA was present in 20/41 patients, of which 13 showed axillary involvement on FDG-PET/CT. An axillary halo was found in eight of these 13 patients. Six out of the 20 patients with FDG-PET-assessed GCA showed no axillary involvement on CDU or FDG-PET/CT. Five of them had single artery involvement on FDG-PET/CT (two aorta; three vertebral artery). One patient had an axillary occlusion on CDU, consistent with FDG-PET/CT results. Overall, sensitivity and specificity of temporal artery CDU was 52% (95% CI: 35, 67) and 93% (95% CI: 84, 97), respectively. Adding axillary artery results improved sensitivity to 71% (95% CI: 55, 84), while specificity did not change.
Presence of an axillary halo or occlusion on CDU is consistent with axillary artery FDG-PET/CT results, but a negative CDU does not rule out axillary involvement. Adding axillary artery assessment to temporal artery assessment may substantially increase the diagnostic performance of CDU.
比较彩色双功能超声（CDU）检查结果与腋窝 18F-氟脱氧葡萄糖（FDG）PET/CT 检查结果，并比较颞动脉和腋窝动脉 CDU 与单纯颞动脉 CDU 的诊断性能。
回顾性纳入疑似巨细胞动脉炎（GCA）的患者。存在晕环或闭塞被认为是 CDU 阳性发现。FDG-PET/CT 评估的腋窝动脉受累定义为腋窝动脉 FDG 摄取高于肝脏摄取。参考标准是 6 个月后的临床诊断，该诊断基于症状和其他诊断测试，除 CDU 外。
在 113 例纳入的患者中，41 例诊断为 GCA。41 例 GCA 患者中有 28 例行 FDG-PET/CT 检查。13 例患者在 FDG-PET/CT 上发现腋动脉晕环，其中 13 例患者在 FDG-PET/CT 上显示腋动脉受累。在这 13 例患者中，有 6 例在 CDU 或 FDG-PET/CT 上未发现腋动脉受累。其中 5 例在 FDG-PET/CT 上表现为单支动脉受累（2 例为主动脉；3 例为椎动脉）。1 例患者在 CDU 上发现腋动脉闭塞，与 FDG-PET/CT 结果一致。总体而言，颞动脉 CDU 的敏感性和特异性分别为 52%（95%CI：35，67）和 93%（95%CI：84，97）。添加腋动脉结果可将敏感性提高至 71%（95%CI：55，84），而特异性不变。
CDU 上出现腋动脉晕环或闭塞与腋动脉 FDG-PET/CT 结果一致，但 CDU 阴性并不能排除腋动脉受累。将腋动脉评估添加到颞动脉评估中可能会显著提高 CDU 的诊断性能。
