Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
RMD Open. 2023 Aug;9(3). doi: 10.1136/rmdopen-2023-003329.
To determine the impact of ultrasound (US) intrinsic limitation to assess aortitis versus FDG-PET/CT in patients with US-proven giant cell arteritis (GCA) and to identify factors associated with aortic involvement.
Retrospective observational study of patients referred to US fast-track clinics at two academic centres over a 4-year period. Only patients with GCA confirmed by US were included. Temporal arteries (TA) and extracranial arteries US were performed at baseline. FDG-PET/CT was performed according to clinician's criteria. An FDG artery uptake at the aorta higher than liver uptake was considered positive for aortitis.
Seventy-two of 186 patients with US-proven GCA underwent an FDG-PET/CT; 29 (40.3%) had a positive FDG-PET/CT and 24 (33.3%) presented aortitis. Only 6 (20.7%) patients with positive FDG-PET/CT had negative US findings of large vessel (LV)-GCA. Among patients with aortitis in FDG-PET/CT, only two (8.3%) had negative US findings of LV-GCA. Patients with aortitis were younger (68.9 vs 81;p<0.001), more frequently females (79.2% vs 39.6%;p=0.002) and had higher platelets count (413.4 vs 311.1;p=0014). Patients with aortitis presented positive TA US less frequently (41.7% vs 83.3%;p<0.001), but more LV US involvement (91.7% vs 41.7%; p<0.001) versus patients without aortitis. None of the patients with aortitis exhibited visual symptoms (0% vs 31.2%;p=0.001).
FDG-PET/CT can detect aortitis in one out of every three patients with US-proven GCA. However, a negative US examination for LV-GCA suggests a low risk of aortitis. Younger and female GCA patients with thrombocytosis, absence of visual manifestations and LV-GCA on US may more frequently present aortitis by FDG-PET/CT.
确定超声（US）固有局限性对评估大动脉炎（GCA）的影响与 FDG-PET/CT 的对比，并确定与主动脉受累相关的因素。
这是一项在 2 家学术中心的 US 快速通道诊所就诊的患者的回顾性观察性研究，在 4 年期间纳入了仅通过 US 确诊的 GCA 患者。基线时进行颞动脉（TA）和颅外动脉 US。根据临床医生的标准进行 FDG-PET/CT。主动脉的 FDG 摄取高于肝脏摄取被认为是主动脉炎阳性。
在 186 例经 US 证实的 GCA 患者中，72 例接受了 FDG-PET/CT；29 例（40.3%） FDG-PET/CT 阳性，24 例（33.3%）存在主动脉炎。仅 6 例（20.7%） FDG-PET/CT 阳性患者的大血管（LV）-GCA 的 US 检查结果为阴性。在 FDG-PET/CT 中存在主动脉炎的患者中，只有 2 例（8.3%）的 LV-GCA 的 US 检查结果为阴性。主动脉炎患者更年轻（68.9 岁 vs 81 岁；p<0.001），更常为女性（79.2% vs 39.6%；p=0.002），血小板计数更高（413.4 vs 311.1；p=0.014）。主动脉炎患者的 TA US 阳性较少（41.7% vs 83.3%；p<0.001），但 LV US 受累更常见（91.7% vs 41.7%；p<0.001），而无主动脉炎患者的情况并非如此。无一例主动脉炎患者出现视觉症状（0% vs 31.2%；p=0.001）。
在经 US 证实的 GCA 患者中，每 3 例患者中就有 1 例可通过 FDG-PET/CT 检测到主动脉炎。然而，LV-GCA 的阴性 US 检查提示主动脉炎的风险较低。年轻和女性 GCA 患者伴有血小板增多症、无视觉表现和 US 上的 LV-GCA 可能更常通过 FDG-PET/CT 出现主动脉炎。
