Pierre Emmanuel Berthod1, Serge Aho-Glélé2, Paul Ornetti3, Olivier Chevallier1, Hervé Devilliers4, Frédéric Ricolfi1, Bernard Bonnotte5, Romaric Loffroy6,7, Maxime Samson5. 1. Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France. 2. Department of Epidemiology and Biostatistics, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France. 3. Department of Rheumatology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France. 4. Department of Internal Medicine and Systemic Diseases, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France. 5. Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France. 6. Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France. romaric.loffroy@chu-dijon.fr. 7. Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079, Dijon Cedex, France. romaric.loffroy@chu-dijon.fr.
Abstract
OBJECTIVES: Giant cell arteritis (GCA) is a large-vessel vasculitis whose diagnosis is confirmed by temporal artery biopsy. However, involvement of large vessels, especially the aorta, can be shown by imaging, which plays an increasing role in GCA diagnosis. The threshold above which aortic wall thickening, as measured by computed tomography (CT), is considered pathological is controversial, with values ranging from 2 to 3 mm. This study assessed aortic morphology by CT scan and its diagnostic value in GCA. METHODS: Altogether, 174 patients were included (64 with GCA, 43 with polymyalgia rheumatica and 67 controls). All patients had a CT scan at diagnosis or at inclusion for controls. Aortic wall thickness, aortic diameter and scores for atheroma were measured. Assessor was blinded to each patient's group. RESULTS: Aortic diameters and atheroma scores were similar between groups. Aortic wall thickness was greater in the GCA group, even after the exclusion of GCA patients with aortic wall thickness ≥3 mm. The receiver operating characteristic (ROC) curve showed that a wall thickness of 2.2 mm was the optimal threshold to diagnose GCA (sensitivity, 67%; specificity, 98%). CONCLUSIONS: Measuring aortic wall thickness by CT scan is effective to diagnose GCA. The optimal threshold to regard aortic wall thickening as pathological was ≥2.2 mm. KEY POINTS: • Imaging, including CT scan, plays an increasing role in GCA diagnosis • CT measurement of aortic wall thickness is useful to diagnose GCA • A 2.2-mm threshold allows the diagnosis of thickened aortic wall in GCA.
OBJECTIVES: Giant cell arteritis (GCA) is a large-vessel vasculitis whose diagnosis is confirmed by temporal artery biopsy. However, involvement of large vessels, especially the aorta, can be shown by imaging, which plays an increasing role in GCA diagnosis. The threshold above which aortic wall thickening, as measured by computed tomography (CT), is considered pathological is controversial, with values ranging from 2 to 3 mm. This study assessed aortic morphology by CT scan and its diagnostic value in GCA. METHODS: Altogether, 174 patients were included (64 with GCA, 43 with polymyalgia rheumatica and 67 controls). All patients had a CT scan at diagnosis or at inclusion for controls. Aortic wall thickness, aortic diameter and scores for atheroma were measured. Assessor was blinded to each patient's group. RESULTS: Aortic diameters and atheroma scores were similar between groups. Aortic wall thickness was greater in the GCA group, even after the exclusion of GCA patients with aortic wall thickness ≥3 mm. The receiver operating characteristic (ROC) curve showed that a wall thickness of 2.2 mm was the optimal threshold to diagnose GCA (sensitivity, 67%; specificity, 98%). CONCLUSIONS: Measuring aortic wall thickness by CT scan is effective to diagnose GCA. The optimal threshold to regard aortic wall thickening as pathological was ≥2.2 mm. KEY POINTS: • Imaging, including CT scan, plays an increasing role in GCA diagnosis • CT measurement of aortic wall thickness is useful to diagnose GCA • A 2.2-mm threshold allows the diagnosis of thickened aortic wall in GCA.
Authors: Olivier Espitia; Maxime Samson; Thomas Le Gallou; Jérôme Connault; Cedric Landron; Christian Lavigne; Cristina Belizna; Julie Magnant; Claire de Moreuil; Pascal Roblot; François Maillot; Elisabeth Diot; Patrick Jégo; Cécile Durant; A Masseau; Jean-Marie Brisseau; Pierre Pottier; Alexandra Espitia-Thibault; Anabele Dos Santos; François Perrin; Mathieu Artifoni; Antoine Néel; Julie Graveleau; Philippe Moreau; Hervé Maisonneuve; Georges Fau; Jean-Michel Serfaty; Mohamed Hamidou; Christian Agard Journal: Autoimmun Rev Date: 2016-02-20 Impact factor: 9.754
Authors: Sergio Prieto-González; Georgina Espígol-Frigolé; Ana García-Martínez; Marco A Alba; Itziar Tavera-Bahillo; José Hernández-Rodríguez; Arturo Renú; Rosa Gilabert; Francisco Lomeña; Maria C Cid Journal: Rheum Dis Clin North Am Date: 2016-09-07 Impact factor: 2.670
Authors: J C Jennette; R J Falk; P A Bacon; N Basu; M C Cid; F Ferrario; L F Flores-Suarez; W L Gross; L Guillevin; E C Hagen; G S Hoffman; D R Jayne; C G M Kallenberg; P Lamprecht; C A Langford; R A Luqmani; A D Mahr; E L Matteson; P A Merkel; S Ozen; C D Pusey; N Rasmussen; A J Rees; D G I Scott; U Specks; J H Stone; K Takahashi; R A Watts Journal: Arthritis Rheum Date: 2013-01