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大血管血管炎的诊断方法

Diagnostic Approaches for Large Vessel Vasculitides.

作者信息

Betrains Albrecht, Blockmans Daniel

机构信息

Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.

Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium.

出版信息

Open Access Rheumatol. 2021 Jun 1;13:153-165. doi: 10.2147/OARRR.S282605. eCollection 2021.

DOI:10.2147/OARRR.S282605
PMID:34113183
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8183517/
Abstract

The large vessel vasculitides comprise giant cell arteritis (GCA), Takayasu arteritis (TAK), and chronic periaortitis. The diagnostic approach to these conditions involves the correct use and interpretation of clinical criteria, imaging techniques, and, in case of GCA, temporal artery biopsy. Ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) reveal a homogeneous, concentric, thickening of the arterial wall. MRI and CT may also reveal aneurysms and stenoses. 18F-Fluorodeoxyglucose (FDG)-PET shows increased FDG uptake of inflamed artery walls delineating increased metabolic activity. Ultrasound, FDG-PET, and MRI are the recommended imaging techniques in GCA and TAK. In patients with a high suspicion of GCA who present with visual disturbances, initiation of high-dose intravenous corticosteroids should not be delayed by imaging. Extracranial large vessel vasculitis may be confirmed by all three modalities, particularly by FDG-PET in case of atypical clinical pictures. In this article, we review the role of the GCA and TAK ACR classification criteria, temporal artery biopsy, conventional angiography, ultrasound, MRI, magnetic resonance angiography (MRA), CT angiography (CTA), and FDG-PET in the diagnostic approach of large vessel vasculitis.

摘要

大血管血管炎包括巨细胞动脉炎（GCA）、大动脉炎（TAK）和慢性主动脉周炎。对这些疾病的诊断方法包括正确使用和解读临床标准、影像学技术，对于GCA患者还包括颞动脉活检。超声、磁共振成像（MRI）和计算机断层扫描（CT）显示动脉壁均匀、同心性增厚。MRI和CT也可能显示动脉瘤和狭窄。18F-氟脱氧葡萄糖（FDG）-PET显示炎症动脉壁的FDG摄取增加，表明代谢活性增强。超声、FDG-PET和MRI是GCA和TAK推荐的影像学技术。对于高度怀疑GCA且出现视觉障碍的患者，不应因影像学检查而延迟高剂量静脉注射皮质类固醇的起始治疗。颅外大血管炎可通过所有这三种检查方式确诊，对于非典型临床表现的病例，尤其通过FDG-PET确诊。在本文中，我们综述了GCA和TAK的美国风湿病学会（ACR）分类标准、颞动脉活检、传统血管造影、超声、MRI、磁共振血管造影（MRA）、CT血管造影（CTA）和FDG-PET在大血管血管炎诊断方法中的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9aef/8183517/c4983b179931/OARRR-13-153-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9aef/8183517/a05d63e051a1/OARRR-13-153-g0001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9aef/8183517/c4983b179931/OARRR-13-153-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9aef/8183517/a05d63e051a1/OARRR-13-153-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9aef/8183517/9cb447a5f955/OARRR-13-153-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9aef/8183517/e1d2fc7d3f1d/OARRR-13-153-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9aef/8183517/aabe7d22754f/OARRR-13-153-g0004.jpg
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Successful Treatment of Diffuse Large B-cell Lymphoma Involving Multiple Renal and Bone Infiltrations Presenting with Giant Cell Arteritis-like Manifestations.成功治疗累及多个肾脏和骨骼浸润并表现为巨细胞动脉炎样表现的弥漫性大 B 细胞淋巴瘤。
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