Vascular involvement in patients with giant cell arteritis determined by duplex sonography of 2x11 arterial regions

Abstract

OBJECTIVE: To define the specificity and extent of duplex sonography (DS) findings suggestive of vessel wall inflammation in patients with giant cell arteritis (GCA). METHODS: Patients admitted between December 2006 and April 2009 to the University Hospital Basel with a suspicion of GCA were eligible for the study. DS of 2x11 arterial regions was performed in all study participants, and American College of Rheumatology criteria were applied to classify patients into GCA or non-GCA groups. RESULTS: GCA was diagnosed in 38 of the 72 participants (53%). A DS pattern suggestive of vessel wall inflammation was not observed in any of the patients in the non-GCA group but, in 21 of the 38 patients with GCA (55%), DS signs suggestive of vessel wall inflammation of > or =1 vessel region were detected. In 12 of the 38 patients with GCA (32%), DS signs of large vessel vasculitis (LVV) were found in > or =1 vessel region(s) of both upper and lower limb vessels. Follow-up DS was performed 6 months after the baseline examination in 9 of the 12 patients with LVV and showed the persistence of most findings despite normalised signs of systemic inflammation. CONCLUSION: DS detects changes in the vessel wall that appear to be specific for GCA; they can be present in upper and lower limb arteries of patients with GCA. Surprisingly, DS-detectable LVV and signs of systemic inflammation are largely dissociated. Basel with a suspicion of GCA were eligible for the study. DS of 2×11 arterial regions was performed in all study participants, and American College of Rheumatology criteria were applied to classify patients into GCA or non-GCA groups.Results GCA was diagnosed in 38 of the 72 participants (53%). A DS pattern suggestive of vessel wall infl ammation was not observed in any of the patients in the non-GCA group but, in 21 of the 38 patients with GCA (55%), DS signs suggestive of vessel wall infl ammation of ≥1 vessel region were detected. In 12 of the 38 patients with GCA (32%), DS signs of large vessel vasculitis (LVV) were found in ≥1 vessel region(s) of both upper and lower limb vessels. Follow-up DS was performed 6 months after the baseline examination in 9 of the 12 patients with LVV and showed the persistence of most fi ndings despite normalised signs of systemic infl ammation. Conclusion DS detects changes in the vessel wall that appear to be specifi c for GCA; they can be present in upper and lower limb arteries of patients with GCA. Surprisingly, DS-detectable LVV and signs of systemic infl ammation are largely dissociated.

Ultrasonography in Diagnosis and Follow-Up of Temporal Arteritis: An Update

“…Stenosis alone demonstrated a very low sensitivity in TA because it was commonly found even in elderly patients without TA, since they are usually affected by arteriosclerosis (Schmidt et al, 1997;Schmidt & GromnicaIhle, 2003, 2005. Conversely acute occlusions, although less frequent than stenosis, were more specific for TA being rarely found in patients without TA (Schmidt et al, 1997;Schmidt & Gromnica-Ihle, 2003, 2005 Since the first description (Schmidt et al, 1997), several studies have been published on the diagnostic value of CDUS in TA with similar results (Aschwanden et al, 2010;Bley et al, 2008;Ghinoi et al, 2008;Houtman et al, 2008;Karahaliou et al, 2006;Lesar et al, 2002;Maldini et al, 2010;Morinobu et al, 2011;Murgatroyd et al, 2003;Nesher et al, 2002;Perez Lopez et al, 2009;Pfadenhauer & Weber, 2003;Reinhard et al, 2004;Romera-Villegas et al, 2004;Salvarani et al, 2002;Schmidt, 2000;Schmidt & Gromnica-Ihle, 2003;Suelves et al, 2010). In the 2005, Karassa and coll.…”

“…(Aschwanden et al, 2010;Kolossvary et al, 2005;Reinhard et al, 2003;Schmidt et al, 2002;Schmidt et al, 2008;). In brachial, subclavian or axillary arteries, CDUS has been shown to be able to demonstrate the typical signs of vascular inflammation such as concentric and hypoechogenic wall thickening of arterial segments, the narrowing of the arterial lumen or a hypoechogenic occlusion.…”

“…CDUS signs in association with clinical symptoms and elevated laboratory markers of systemic inflammation can be considered diagnostic for large-vessel vasculitis making it unnecessary to use of conventional angiography (Tato & www.intechopen.com Hoffmann, 2008). With regard to the involvement of lower limbs in GCA, CDUS semeiology of femoropopliteal and crural arteries appears to be the same as in the vessels of the upper limbs (Aschwanden et al, 2010;Schmidt et al, 2002;Tato & Hoffmann, 2006;) …”

Incidence and Prognostic Implications of Diplopia in Patients with Giant Cell Arteritis

“…Briefly, patients presenting at the University Hospital Basel with newly diagnosed GCA according to American College of Rheumatology criteria 9 were included after having given informed consent. Demographic, clinical, laboratory, and radiologic (including vascular ultrasound 10 ) data of all patients were recorded at diagnosis and during followup. All patients with ophthalmologic symptoms were referred to further detailed ophthalmologic and orthoptic examinations.…”

Lumpers and Splitters: Ongoing Issues in the Classification of Large Vessel Vasculitis

“…The prevalence of large vessel disease in patients with GCA can vary widely depending upon the imaging modality used to screen for disease (angiography 20-30% 3,4 ; positron emission tomography 30-80% 14,15 ; ultrasound 30% 16,17,18 ). In the study by Furuta, et al, an arterial lesion was defined by either increased wall thickness or stenosis/occlusion or aneurysm attributed to vasculitis, detected by computed tomography or magnetic resonance imaging angiography.…”