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1.
Neth J Med ; 74(5): 182-92, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27323671

ABSTRACT

A systematic literature search was performed to summarise current knowledge on extracranial giant cell arteritis (GCA), i.e. large-artery involvement in patients with or without clinically apparent temporal arteritis (cranial GCA). Extracranial GCA is increasingly recognised, both in patients with cranial GCA and with solitary extracranial GCA, due to increased awareness among physicians and development of modern imaging modalities. The literature on the pathogenesis and histopathology of extracranial GCA is scarce. It is considered to be similar to cranial GCA. Patients with solitary extracranial GCA often present with non-specific signs and symptoms, although vascular manifestations, mostly secondary to stenosis, may occur. Due to the non-specific clinical presentation and low sensitivity of temporal artery biopsies, extracranial GCA is usually diagnosed by imaging. 18F-FDG-PET, MRI, CT angiography and ultrasound are used for this purpose. At present, the optimal diagnostic strategy is undetermined. The choice for a particular modality can be guided by the clinical scenario that raises suspicion of extracranial GCA, in addition to local availability and expertise. Extracranial complications in GCA consist of aortic aneurysm or dissection (mainly the ascending aorta), aortic arch syndrome, arm claudication and posterior stroke (although this is technically a cranial complication, it often results from stenosis of the vertebrobasilar arteries). Mortality is generally not increased in patients with GCA. Treatment of patients with solitary extracranial and those with extracranial and cranial GCA has been debated in the recent literature. In general, the same strategy is applied as in patients with temporal arteritis, although criteria regarding who to treat are unclear. Surgical procedures may be indicated, in which case optimal medical treatment prior to surgery is important.


Subject(s)
Aortitis/diagnostic imaging , Carotid Artery Diseases/diagnostic imaging , Giant Cell Arteritis/diagnostic imaging , Aortic Dissection/etiology , Aortic Aneurysm/etiology , Aortic Arch Syndromes/etiology , Aortitis/complications , Aortitis/pathology , Aortitis/therapy , Axillary Artery/diagnostic imaging , Axillary Artery/pathology , Biopsy , Carotid Artery Diseases/complications , Carotid Artery Diseases/pathology , Carotid Artery Diseases/therapy , Computed Tomography Angiography , Femoral Artery/diagnostic imaging , Femoral Artery/pathology , Fluorodeoxyglucose F18 , Giant Cell Arteritis/complications , Giant Cell Arteritis/pathology , Giant Cell Arteritis/therapy , Glucocorticoids/therapeutic use , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/pathology , Immunosuppressive Agents/therapeutic use , Magnetic Resonance Angiography , Mesenteric Arteries/diagnostic imaging , Mesenteric Arteries/pathology , Positron Emission Tomography Computed Tomography , Prognosis , Radiopharmaceuticals , Renal Artery/diagnostic imaging , Renal Artery/pathology , Subclavian Artery/diagnostic imaging , Subclavian Artery/pathology , Temporal Arteries/diagnostic imaging , Temporal Arteries/pathology , Vascular Surgical Procedures
2.
Biomed Res Int ; 2015: 914692, 2015.
Article in English | MEDLINE | ID: mdl-25695092

ABSTRACT

INTRODUCTION: (18)F-FDG-PET visualises inflammation. Both atherosclerosis and giant cell arteritis cause vascular inflammation, but distinguishing the two may be difficult. The goal of this study was to assess interobserver agreement and diagnostic accuracy of (18)F-FDG-PET for the detection of large artery involvement in giant cell arteritis (GCA). METHODS: 31 (18)F-FDG-PET/CT scans were selected from 2 databases. Four observers assessed vascular wall (18)F-FDG uptake, initially without and subsequently with predefined observer criteria (i.e., vascular wall (18)F-FDG uptake compared to liver or femoral artery (18)F-FDG uptake). External validation was performed by two additional observers. Sensitivity and specificity of (18)F-FDG-PET were determined by comparing scan results to a consensus diagnosis. RESULTS: The highest interobserver agreement (kappa: 0.96 in initial study and 0.79 in external validation) was observed when vascular wall (18)F-FDG uptake higher than liver uptake was used as a diagnostic criterion, although agreement was also good without predefined criteria (kappa: 0.68 and 0.85). Sensitivity and specificity were comparable for these methods. The criterion of vascular wall (18)F-FDG uptake equal to liver (18)F-FDG uptake had low specificity. CONCLUSION: Standardization of image assessment for vascular wall (18)F-FDG uptake promotes observer agreement, enables comparative studies, and does not appear to result in loss of diagnostic accuracy compared to nonstandardized assessment.


Subject(s)
Arteries/pathology , Fluorodeoxyglucose F18 , Vasculitis/diagnosis , Aged , Atherosclerosis/diagnosis , Atherosclerosis/pathology , Female , Giant Cell Arteritis/diagnosis , Giant Cell Arteritis/pathology , Humans , Inflammation/diagnosis , Inflammation/pathology , Male , Observer Variation , Positron-Emission Tomography/methods , Radiopharmaceuticals , Reproducibility of Results , Sensitivity and Specificity , Tomography, X-Ray Computed/methods , Vasculitis/pathology
3.
Neth J Med ; 70(2): 81-3, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22418754

ABSTRACT

Posterior ischaemic stroke is relatively uncommon, and its occurrence should alert clinicians to possible uncommon underlying disease. We report a patient with occipital brain infarction. The combination of age, gender, general malaise and elevated erythrocyte sedimentation rate led to the clinical suspicion of giant cell arteritis. Vertebral artery vasculitis was confirmed by 18-FD G positron emission tomography, combined with CT angiography, and immediate immunosuppressive therapy was started. Symptoms of stroke should, in a particular clinical context, raise suspicion of giant cell arteritis.


Subject(s)
Brain Infarction/diagnosis , Giant Cell Arteritis/diagnosis , Vertebrobasilar Insufficiency/diagnosis , Aged , Angiography , Blood Sedimentation , Brain Infarction/blood , Brain Infarction/diagnostic imaging , Diagnosis, Differential , Female , Giant Cell Arteritis/blood , Giant Cell Arteritis/diagnostic imaging , Humans , Positron-Emission Tomography/methods , Vertebrobasilar Insufficiency/blood , Vertebrobasilar Insufficiency/diagnostic imaging
4.
Clin Rheumatol ; 31(5): 861-71, 2012 May.
Article in English | MEDLINE | ID: mdl-22322206

ABSTRACT

The purpose of this study was to identify clinical and laboratory parameters that may improve the effectiveness of the use of fluorodeoxyglucose positron emission tomography ((18)F-FDG PET)(/CT) for diagnosing large vessel vasculitis (LVV), and secondarily to assess the contribution of (18)F-FDG PET/CT in finding other diagnoses for patients without signs of LVV on the scan. A multicenter retrospective study of (18)F-FDG PET(/CT) scans performed between January 2000 and December 2009 for clinical suspicion of LVV was conducted. A total of 304 (18)F-FDG PET(/CT) scans were included, of which 62 (20%) were positive and 242 (80%) were negative for LVV. Univariate analysis showed that patients with a positive scan were older (65.9 ± 13.4 versus 58.6 ± 16.5 years, p = 0.002), were more frequently female (76% versus 55%, p = 0.002), more often had a history of temporal arteritis (10% versus 3%, p = 0.044), less frequently had artralgia (31% versus 67%, p = 0.000), and had higher thrombocyte counts (434 ± 161 versus 373 ± 168 × 10(9)/l, p = 0.049) and a higher erythrocyte sedimentation rate (ESR) (72.6 ± 31.0 versus 51.4 ± 30.5 mm/h, p = 0.001) than patients with a negative scan. In the multivariate analysis, only artralgia (OR 0.091; 95% CI 0.023-0.366) and ESR (OR 1.024; 95% CI 1.002-1.046) remained statistically significant predictors. The presence of artralgia is a statistically significant negative predictor and an elevated ESR a statistically significant positive predictor of LVV showing up on (18)F-FDG PET(/CT). A reliable prediction of the outcome of the scan, based on these two parameters, is not possible however. (18)F-FDG PET(/CT) allows early diagnosis of LVV and may discover occult inflammatory or neoplastic disorders.


Subject(s)
Fluorodeoxyglucose F18 , Giant Cell Arteritis/diagnosis , Positron-Emission Tomography/methods , Radiopharmaceuticals , Aged , Early Diagnosis , Female , Giant Cell Arteritis/blood , Giant Cell Arteritis/complications , Humans , Male , Middle Aged , Neoplasms/blood , Neoplasms/diagnosis , Retrospective Studies
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