Ultrasonographic and FDG-PET imaging in active giant cell arteritis of the carotid arteries

VASA ◽  
2005 ◽  
Vol 34 (4) ◽  
pp. 269-271 ◽  
Author(s):  
Pfadenhauer ◽  
Rüll
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Arterial Wall ◽  
Carotid Arteries ◽  
Temporal Arteritis ◽  
Temporal Artery ◽  
Metabolic Imaging ◽  
Atypical Manifestations

Inflammation of the arterial wall has been demonstrated by 18 Fluoro-Deoxyglucose PET imaging in patients with Takayasu’s and temporal arteritis. We used ultrasonography and FDG-PET for structural and metabolic imaging of the carotid artery to diagnose giant cell arteritis without biopsy. In a 72 years old patient with isolated clinical and paraclinical signs of severe systemic inflammation ultrasonogaphy showed concentric hypoechogenic mural thickening of the carotid arteries and high FDG uptake in the left carotid, both axillary and subclavian arteries and the aorta. Clinical and paraclinical abnormalities showed a typical response to steroid treatment. In conclusion a combined approach using ultrasound and FDG-PET seems to be helpful in the diagnosis of GCA of large arteries particularily in patients with atypical manifestations of the disease and negative or unavailable biopsy of the temporal artery.

scholarly journals AB0501 THREE CASES OF VERTEBRAL ARTERITIS IDENTIFIED ON FDG-PET IN PATIENTS WITH SUSPECTED GCA AT UNIVERSITY COLLEGE LONDON HOSPITAL (UCLH)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1549.2-1549
Author(s):  
D. Ludwig ◽  
M. Naja ◽  
S. Voo ◽  
V. Morris
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Immunosuppressive Treatment ◽  
Temporal Artery ◽  
Large Vessel ◽  
Diagnostic Tools ◽  
History Of ◽  
Vessel Involvement

Background:Giant cell arteritis (GCA) may affect both cranial and extra-cranial vessels; where the latter occurs, it can be termed large-vessel GCA (LV-GCA). Large vessel involvement is common: histological evidence has been seen in 80% of autopsies of patients with known GCA, and imaging studies suggest large vessel involvement in over 80%1. LV-GCA is important to diagnose due to the risks of vascular complications such as occlusion and ischaemic stroke. The clinical diagnosis can be challenging, and the American College of Rheumatology (ACR) GCA classification criteria often underperform in cases of LV-GCA1. F-fluorodeoxyglucose positron emission tomography (FDG-PET) has been found to be useful in the detection of extra-cranial involvement to support the diagnosis of LV-GCA.2Objectives:To appreciate the variability in presentation of cases of LV-GCA, and to further characterise a subgroup of patients with vertebral arteritis.To explore the use of FDG-PET imaging in GCA patients in addition to or in place of traditional diagnostic tools (temporal artery ultrasound / biopsy).Methods:Through evaluation of the new GCA fast-track pathway implemented at UCLH, a subgroup of patients diagnosed with vertebral arteritis was identified. The history and presentation of these patients were analysed.Results:Three patients were diagnosed with vertebral arteritis. All three were male, Caucasian and aged over 70. All were investigated for GCA due to a history of severe headache (frontal in one, occipital in one, bi-temporal in one) with associated red flag symptoms. Two had a history of jaw claudication and visual disturbances (unilateral visual loss in one, transient diplopia in the other). Both of these patients had positive temporal artery biopsies. The third patient had no ischaemic symptoms but a strong history of prominent polymyalgic features and a positive temporal artery ultrasound. Inflammatory markers were raised in two, and normal in one, of the patients. Only one had systemic symptoms (weight loss). All three proceeded to FDG-PET scans which showed vertebral arteritis and were commenced on immunosuppressive treatment.Conclusion:The cases discussed illustrate the heterogeneity of the presentation of LV-GCA, and the diagnostic challenge this poses. FDG-PET imaging is useful in confirming extra-cranial involvement and therefore guiding treatment.References:[1]Large-vessel giant cell arteritis: diagnosis, monitoring and management.Matthew J Koster, Eric L Matteson, Kenneth J Warrington.2018, Rheumatology, Vol. 57, pp. 32-42.[2]EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice.Dejaco C, Ramiro S, Duftner C, et al.2018, Annals of the Rheumatic Diseases, Vol. 77, pp. 636-643.Disclosure of Interests: :None declared

scholarly journals Scalp Necrosis Revealing Severe Giant-Cell Arteritis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Safa Idoudi ◽  
Marouene Ben Kahla ◽  
Fares Mselmi ◽  
Badreddine Sriha ◽  
A. Guiga ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Carotid Arteries ◽  
Temporal Arteritis ◽  
Temporal Artery ◽  
The Elderly ◽  
Rare Occurrence ◽  
Irreversible Loss ◽  
Scalp Necrosis ◽  
Primary Vasculitis

Giant-cell arteritis (GCA), also referred to as temporal arteritis, is the most common primary vasculitis of the elderly involving the extracranial branches of the carotid arteries, in particular, the temporal artery. Patients usually present with temporal headaches, visual impairment, fever, and scalp tenderness. Scalp necrosis associated with GCA is a rare occurrence with approximately 100 cases reported in the literature to date. It is a therapeutic emergency requiring urgent management as it may lead to irreversible loss of vision. To increase awareness of this severe complication, we report a patient with a scalp necrosis revealing a GCA.

Polymyalgia rheumatica and temporal arteritis

2010 ◽  
pp. 3678-3683
Author(s):  
Jan Tore Gran
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Histological Examination ◽  
Polymyalgia Rheumatica ◽  
Temporal Arteritis ◽  
Superficial Temporal Artery ◽  
Granulomatous Inflammation ◽  
Temporal Artery ◽  
Unknown Aetiology ◽  
Inflammatory Conditions

Polymyalgia rheumatica and temporal arteritis are distinct but overlapping inflammatory conditions of unknown aetiology. They almost exclusively affect people over 50 years of age, women more than men (ratio 2–3:1), and particularly those of Nordic heritage. Temporal arteritis is characterized by granulomatous inflammation that penetrates all layers of the wall of medium and (often) large muscular arteries, in particular the superficial temporal artery. Histological examination of tissues from patients with polymyalgia rheumatica shows nonspecific changes only. The term ‘giant cell arteritis’ is properly used only to describe patients with biopsy-proven arteritis....

Giant Cell Arteritis (GCA): Pathogenesis, Clinical Aspects and Treatment Approaches

2019 ◽  
Vol 15 (4) ◽  
pp. 259-268
Author(s):  
Andrea Ciofalo ◽  
Giampiero Gulotta ◽  
Giannicola Iannella ◽  
Benedetta Pasquariello ◽  
Alessandra Manno ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Arterial Wall ◽  
Clinical Manifestations ◽  
Temporal Artery ◽  
Clinical Aspects ◽  
Iliac Arteries ◽  
Treatment Approaches ◽  
Tissue Ischemia ◽  
Number Of Patients

: Giant Cell Arteritis (GCA), or Horton’s Arteritis, is a chronic form of vasculitis of the large and medium vessels, especially involving the extracranial branches of the carotid arteries, in particular, the temporal artery, with the involvement of the axillary, femoral and iliac arteries too. Arterial wall inflammation leads to luminal occlusion and tissue ischemia, which is responsible for the clinical manifestations of the disease. : A substantial number of patients affected by GCA present head and neck symptoms, including ocular, neurological and otorhinolaryngological manifestations. : The aim of this article is to present pathogenesis, clinical aspects and treatment approaches of GCA manifestations.

Polymyalgica rheumatica and giant cell arteritis

2008 ◽  
Vol 18 (2) ◽  
pp. 91-101 ◽  
Author(s):  
H A Bird ◽  
Helen Mac Iver
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Polymyalgia Rheumatica ◽  
Visual Loss ◽  
Temporal Arteritis ◽  
Morning Stiffness ◽  
Temporal Artery ◽  
Shoulder Girdle ◽  
Pelvic Girdle ◽  
Disease Spectrum

Polymyalgia rheumatica and giant cell arteritis are closely related conditions, considered by many to represent opposite poles of a single disease spectrum. They can occur together or separately.Polymyalgia rheumatica is characterized by pain and morning stiffness in the shoulder girdle and sometimes the pelvic girdle. The symptoms are felt to be related to synovitis of proximal joints and extra-articular synovial structures. Giant cell arteritis displays a frank vasculitis affecting the regions supplied by the temporal artery to give visual loss and scalp tenderness but is increasingly recognized to also affect the aorta and its extra-cranial branches. For this reason the term ‘giant cell arteritis’, which is descriptive of the pathology, is used instead of the alternative term ‘temporal arteritis’, which gives a misleading impression of localization but which was the term used in previous reviews for this journal, the most recent in 2003.

scholarly journals Bilateral Vertebral Artery Vasculitis—A Rare Manifestation of Giant Cell Arteritis and a Difficult Diagnosis Made Possible by 2-[18F]FDG PET/CT

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 879
Author(s):  
Natasja Justesen ◽  
Michael Hansen ◽  
Mads Jensen ◽  
Oliver Klefter ◽  
Jane Brittain ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Fdg Pet ◽  
Temporal Artery ◽  
High Dose ◽  
Temporal Artery Biopsy ◽  
Glucocorticoid Treatment ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

: Giant cell arteritis (GCA) is the most common form of large vessel vasculitis. GCA is a medical and ophthalmological emergency, and rapid diagnosis and treatment with high-dose corticosteroids is critical in order to reduce the risk of stroke and sudden irreversible loss of vision. GCA can be difficult to diagnose due to insidious and unspecific symptoms—especially if typical superficial extracranial arteries are not affected. In these cases, verification of clinical diagnosis using temporal artery biopsy is not possible. This example illustrates the diagnostic value of hybrid imaging with 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT), and the limitations of the temporal artery biopsy in bilateral vertebral GCA, causing transient ischemic attack in the visual cortex. In addition it indicates that inflammation in the artery wall can be visualized on 2-[18F]FDG PET/CT despite long term and ongoing high dose glucocorticoid treatment.

Introducing an ANP-led temporal artery biopsy service for patients with suspected giant cell arteritis

2021 ◽  
Vol 30 (9) ◽  
pp. 512-519
Author(s):  
John Cooper
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Nurse Practitioner ◽  
Temporal Arteritis ◽  
Temporal Artery ◽  
Medical Emergency ◽  
Temporal Artery Biopsy ◽  
Sight Loss

Giant cell arteritis (GCA) is an uncommon autoimmune inflammatory vasculopathy that can lead to the destruction and occlusion of various arteries that consequently can cause serious complications such as stroke or sight loss. It is seen as a medical emergency. The most commonly affected vessel in GCA is the temporal artery in the side of the head, hence the condition is sometimes also referred to as ‘temporal arteritis’. This article discusses the introduction of an advanced nurse practitioner-led temporal artery biopsy service.

scholarly journals Temporal Artery Vascular Diseases

2022 ◽  
Vol 11 (1) ◽  
pp. 275
Author(s):  
Hélène Greigert ◽  
André Ramon ◽  
Georges Tarris ◽  
Laurent Martin ◽  
Bernard Bonnotte ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Arteritis ◽  
Checkpoint Inhibitors ◽  
Vascular Diseases ◽  
Temporal Artery ◽  
Immunoglobulin G4 ◽  
Varicella Zoster ◽  
Related Disease ◽  
Anca Associated Vasculitis

In the presence of temporal arteritis, clinicians often refer to the diagnosis of giant cell arteritis (GCA). However, differential diagnoses should also be evoked because other types of vascular diseases, vasculitis or not, may affect the temporal artery. Among vasculitis, Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is probably the most common, and typically affects the peri-adventitial small vessel of the temporal artery and sometimes mimics giant cell arteritis, however, other symptoms are frequently associated and more specific of ANCA-associated vasculitis prompt a search for ANCA. The Immunoglobulin G4-related disease (IgG4-RD) can cause temporal arteritis as well. Some infections can also affect the temporal artery, primarily an infection caused by the varicella-zoster virus (VZV), which has an arterial tropism that may play a role in triggering giant cell arteritis. Drugs, mainly checkpoint inhibitors that are used to treat cancer, can also trigger giant cell arteritis. Furthermore, the temporal artery can be affected by diseases other than vasculitis such as atherosclerosis, calcyphilaxis, aneurysm, or arteriovenous fistula. In this review, these different diseases affecting the temporal artery are described.

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