Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
Clinic of Nuclear Medicine, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
RMD Open. 2022 Aug;8(2). doi: 10.1136/rmdopen-2022-002464.
Giant cell arteritis (GCA) with the involvement of extracranial vessels is increasingly coming into focus. Isolated aortic involvement in the acute phase of GCA is probably more frequent than estimated because only a minority of patients show typical symptoms. F-fluorodeoxyglucose positron emission tomography/CT (PET/CT) is a reliable imaging tool to diagnose patients with extracranial GCA. The aim of this retrospective study was to quantify arterial involvement at the onset of a newly diagnosed GCA by PET/CT and to evaluate the influence of glucocorticoid (GC) treatment on the diagnostic performance of this imaging technique.
The study included 60 patients with GCA at the onset of a GCA. All patients had undergone a PET/CT scan. 44 patients were GC naïve and 16 patients received GC.
The most affected arteries were the ascending aorta (72%), followed by the brachiocephalic trunk (62%), aortic arch (60%) and descending aorta (60%). The aorta and its branches showed an inflammatory involvement in 83.3% of patients. A singular affection of the aorta and the brachiocephalic trunk was revealed in 20% of cases. GC-naïve patients (95.5%) had more frequently affected arteries compared with GC-treated patients (50%).
Our study showed the frequent involvement of the thoracic aorta and brachiocephalic trunk in patients with GCA using PET/CT. Since these vascular compartments cannot be visualised by ultrasound, we advocate screening imaging of the aorta with PET/CT when GCA is suspected. Because the use of GC is associated with a marked decrease in the inflamed vascular segment in GCA, PET/CT should be performed as soon as possible.
巨细胞动脉炎（GCA）伴颅外血管受累的情况越来越受到关注。在 GCA 的急性期，孤立的主动脉受累可能比估计的更为常见，因为只有少数患者表现出典型症状。18F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）是诊断颅外 GCA 的一种可靠影像学工具。本回顾性研究的目的是通过 PET/CT 定量诊断新诊断的 GCA 患者的动脉受累情况，并评估糖皮质激素（GC）治疗对该影像学技术诊断性能的影响。
该研究纳入了 60 例 GCA 初诊患者。所有患者均接受了 PET/CT 扫描。44 例患者为 GC 初治患者，16 例患者接受了 GC 治疗。
最常受累的动脉为升主动脉（72%），其次为头臂干（62%）、主动脉弓（60%）和降主动脉（60%）。83.3%的患者主动脉及其分支有炎症受累。20%的病例显示主动脉和头臂干的单一受累。GC 初治患者（95.5%）较 GC 治疗患者（50%）更常出现动脉受累。
我们的研究表明，PET/CT 检查可显示 GCA 患者的胸主动脉和头臂干常受累。由于这些血管节段不能通过超声显示，我们主张在怀疑 GCA 时进行主动脉的筛查性影像学检查。由于 GC 的使用与 GCA 中炎症血管节段的显著减少相关，因此应尽快进行 PET/CT 检查。
