Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain.
Department of Internal Medicine, Hospital Carlos III, Madrid, Spain.
Arthritis Res Ther. 2023 Feb 14;25(1):23. doi: 10.1186/s13075-023-03002-0.
To determine the diagnostic discriminant validity between large vessel giant cell arteritis (LV-GCA) and atherosclerosis using ultrasound (US) intima-media thickness (IMT) measurements.
We included 44 patients with LV-GCA and 42 with high-risk atherosclerosis. US examinations of the axillary, subclavian, and common carotid arteries (CCA) were systematically performed using a MylabX8 system (Genoa, Italy) with a 4-15-MHz probe. IMT ≥ 1 mm was accepted as pathological.
The LV-GCA cohort included 24 females and 20 males with a mean age of 72.8 ± 7.6 years. The atherosclerosis group included 25 males and 17 females with a mean age of 70.8 ± 6.5 years. The mean IMT values of all arteries included were significantly higher in LV-GCA than in atherosclerosis. Among LV-GCA patients, IMT ≥ 1 mm was seen in 31 axillary, 30 subclavian, and 28 CCA. In the atherosclerotic cohort, 17 (38.6%) had IMT ≥ 1 mm with axillary involvement in 2 patients, subclavian in 3 patients, carotid distal in 14 patients (5 bilateral), and isolated carotid proximal affectation in 1 case. A cutoff point greater than 1 pathological vessel in the summative count of axillary and subclavian arteries or at least 3 vessels in the count of six vessels, including CCA, showed a precision upper 95% for GCA diagnosis.
The IMT is higher in LV-GCA than in atherosclerosis. The proposed US halo count achieves an accuracy of > 95% for the differential diagnosis between LV-GCA and atherosclerosis. The axillary and subclavian arteries have higher discriminatory power, while carotid involvement is less specific in the differential diagnosis.
利用超声（US）内膜中层厚度（IMT）测量来确定巨细胞动脉炎（GCA）与动脉粥样硬化之间的诊断鉴别效度。
我们纳入了 44 例巨细胞动脉炎（LV-GCA）患者和 42 例高危动脉粥样硬化患者。使用 MylabX8 系统（意大利热那亚）和 4-15MHz 探头对腋动脉、锁骨下动脉和颈总动脉（CCA）进行了系统的 US 检查。将 IMT≥1mm 作为病理性。
LV-GCA 队列包括 24 名女性和 20 名男性，平均年龄为 72.8±7.6 岁。动脉粥样硬化组包括 25 名男性和 17 名女性，平均年龄为 70.8±6.5 岁。所有动脉的平均 IMT 值在 LV-GCA 中明显高于动脉粥样硬化组。在 LV-GCA 患者中，31 例腋动脉、30 例锁骨下动脉和 28 例 CCA 的 IMT≥1mm。在动脉粥样硬化组中，17 例（38.6%）存在 IMT≥1mm，2 例累及腋动脉，3 例累及锁骨下动脉，14 例累及颈总动脉远段（5 例双侧），1 例累及颈总动脉近段。腋动脉和锁骨下动脉累积计数中存在 1 个以上病理性血管或 6 个血管（包括 CCA）计数中存在 3 个以上血管时，截断点大于 1，对 GCA 诊断的准确率达到 95%以上。
LV-GCA 的 IMT 高于动脉粥样硬化。所提出的 US 晕环计数对 LV-GCA 与动脉粥样硬化之间的鉴别诊断具有 95%以上的准确性。腋动脉和锁骨下动脉具有更高的鉴别能力，而颈动脉受累在鉴别诊断中特异性较低。
