scholarly journals SAT0262 PROPOSAL FOR OPTIMIZATION OF DIAGNOSTIC IMAGING FOR GIANT CELL ARTERITIS USING THREE-DIMENSIONAL COMPUTED TOMOGRAPHY ANGIOGRAPHY IMAGE AND CONSTRUCTING VASCULAR MAPPING FROM VASCULAR ULTRASONOGRAPHY AS REFERENCES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1073.2-1074
Author(s):  
T. Kawamoto ◽  
M. Ogasawara ◽  
Y. Mastuki-Muramoto ◽  
T. Kawaguchi ◽  
S. Ando ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Imaging ◽  
Giant Cell ◽  
Computed Tomography Angiography ◽  
Three Dimensional ◽  
Imaging Findings ◽  
Imaging Methods ◽  
Vascular Ultrasonography ◽  
Pet Ct ◽  
Vascular Mapping

Background:The development of rapid and accurate methods of diagnosing giant cell arteritis (GCA) is critical to prevent blindness and stroke, which may develop rapidly in patients with GCA. In 2018, EULAR published recommendations that the first imaging modality for GCA should be vascular ultrasonography without biopsy. However, many institutions still consider biopsy to make an important contribution to the diagnosis of GCA.Objectives:Our purpose is to eliminate blindness and stroke among GCA patients by optimizing diagnostic imaging and method to diagnose GCA employed by vascular ultrasonography (V-US), CT Angiography (CTA), MRI/A, and PET/CT without biopsy.Methods:We evaluated the clinical and serological characteristics of 20 patients who were diagnosed with GCA at our hospital from 2012 to 2018, and compared the image and biopsy findings of these patients. We then evaluated the effect of optimizing diagnostic imaging and methods for patients with suspected GCA who visited our hospital during 2019. Vascular mapping was carried out using V-US for 3DCTA and other imaging methods as references.Results:Table 1 shows the clinical characteristics of the study population. The sensitivity of CTA for GCA was 85.7% (12 of 14 patients), which was the highest of the studied imaging methods. All biopsy-positive cases were diagnosed as GCA, and we compared these cases with cases with positive imaging findings. This revealed that CTA findings were correct (i.e., positive) in 66.7% (four of six patients), MRI/A findings were correct in in 33.3% (three of nine), V-US findings were correct in 50.0% (three of six). Therefore, CTA exhibited the highest sensitivity for positive findings. Comparison of biopsy-positive cases with cases in which imaging findings were negative revealed that CTA findings were correct (negative) in 33.3% (two of six patients), MRI/A findings were correct in 55.6% (five of nine), V-US was correct in 50.0% (three of six). Thus, CTA had the lowest sensitivity for negative findings. Comparison of CTA findings of positive cases with other imaging modalities which reported positive findings revealed MRI/A findings to be correct in 44.4% (four of nine patients), PET/CT findings to be correct in 50.0% (one of two), V-US to be correct in 63.3% (five of eight). Thus, V-US had the highest agreement with CTA. We carried out vascular mapping by V-US using 3DCTA and other imaging methods and produced references to improve the accuracy of diagnosis. Using these references, we diagnosed five cases of GCA among the 20 patients; the positive predictive value of V-US was 80% (four of five patients) and negative predictive value was 86.7% (13 of 15 patients).Table 1.Baseline characteristics of the study sample    The number of biopsies performed decreased from 50% (10 of 20 patients) from 2012 to 2018 to 15% (3 of 20 patients) in 2019. Two cases in the present study had positive findings in both biopsy and V-US; in one case, biopsy, CTA, and MRI/A were negative while V-US revealed positive findings. No patients with GCA developed blindness or stroke during 2019.Conclusion:We propose that V-US should be performed as the first examination for the diagnosis of GCA by the creation of vascular mappings when GCA is suspected in order to prevent blindness and stroke.References:[1]Christian Dejaco et al.EULAR recommendations for the use of imaging in large vasculitis in clinical practice.Annals of the Rheumatic Diseases,2018 May;77(5):636-643[2]Kawamoto T et al.Diagnosis of giant cell arthritis by head-contrast three-dimensional computed tomography angiography.Journal of Medical Case Reports2019 Sep 11;13(1):285.Figure 1.Left side is before, right side is after thrapy. (A) 3DCTA finding, (B) determination of V-US arrangement with vascular location to evaluate wall thickening of V-US, compression sign, stenosis and stoppage of vessels.Disclosure of Interests:None declared

scholarly journals Diagnosis of giant cell arteritis by head-contrast three-dimensional computed tomography angiography: two case reports

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Toshio Kawamoto ◽  
Michihiro Ogasawara ◽  
Souichiro Nakano ◽  
Yuko Matsuki−Muramoto ◽  
Masakazu Matsushita ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Magnetic Resonance Angiography ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Computed Tomography Angiography ◽  
Three Dimensional ◽  
Temporal Artery ◽  
Emission Tomography ◽  
Positron Emission

Abstract Introduction Temporal artery biopsy is essential for the diagnosis of giant cell arteritis. It has been shown that 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance angiography, and ultrasonography are useful for the diagnosis of giant cell arteritis. However, there are only a few reports on the usefulness of three-dimensional computed tomography angiography in the diagnosis of giant cell arteritis. We describe two cases in which giant cell arteritis was difficult to diagnose using positron emission tomography-computed tomography and magnetic resonance angiography but was diagnosed using three-dimensional computed tomography angiography, thus showing the importance of three-dimensional computed tomography angiography in the diagnosis of giant cell arteritis. Case presentation Case 1: An 81-year-old Japanese man. Laboratory investigations revealed normocytic anemia and raised inflammatory marker levels. Slight bleeding in the right posterior pole of his eyeball and leukoma of his left cornea were observed on fundus examination. Stenosis and stoppage of the temporal artery were detected on three-dimensional computed tomography angiography. A diagnosis of giant cell arteritis was made, and he was started on orally administered prednisolone. His headache and C-reactive protein levels improved. Four weeks after glucocorticoid steroid treatment, three-dimensional computed tomography angiography revealed improvement in stenosis and stoppage of temporal artery. Case 2: A 74-year-old Japanese woman. A dose of 20 mg of prednisolone was administered and her polymyalgia and polyarthritis improved; however, her headache and ear occlusion persisted. Although vasculitis was not detected on positron emission tomography-computed tomography, stenosis and stoppage of the temporal artery were detected on computed tomography angiography. She was diagnosed as having giant cell arteritis and started on orally administered prednisolone treatment (60 mg daily). Her headache and C-reactive protein levels improved. Four weeks after glucocorticoid treatment, three-dimensional computed tomography angiography showed improvement in stenosis and stoppage of temporal artery. Conclusions In both patients with giant cell arteritis, three-dimensional computed tomography angiography revealed improvement in stenosis and stoppage of temporal artery after glucocorticoid treatment. We conclude that computed tomography angiography along with magnetic resonance angiography, positron emission tomography-computed tomography, and ultrasonography are important for the diagnosis of giant cell arteritis.

scholarly journals Variant Anatomy of the Renal Arteries: a Computed Tomography Angiography Study

2020 ◽  
Vol 9 (1) ◽  
pp. 43-48
Author(s):  
A. V. Kolsanov ◽  
A. K. Nazaryan ◽  
A. S. Voronin ◽  
O. A. Gelashvili
Keyword(s):  
Computed Tomography ◽  
Clinical Practice ◽  
Renal Artery ◽  
Computed Tomography Angiography ◽  
Three Dimensional ◽  
Renal Arteries ◽  
Software Complex ◽  
Three Dimensional Modeling ◽  
Dimensional Modeling ◽  
Variant Anatomy

The article discusses variant anatomy of the renal arteries, potentials of three-dimensional modeling and use of these data in clinical practice. Despite a large number of studies based on both morphological and clinical approaches there is no general consensus regarding options for dividing the renal artery, the number of its branches, their topolocalization. This is due to the fact that most of the research studies are based on cadaveric material, fixed and unfixed. It is difficult to apply these data to explain medical conditions and pathologies of particular patients. Computed tomography allows performing in vivo investigation of various morphometric parameters of the renal arteries, and these findings can subsequently be used in disease diagnostics and treatment.The aim of the study was to identify patterns of topography, linear dimensions and variant anatomy of the human renal arteries based on computed tomography angiography (CTA) with three-dimensional modeling, and to apply CTA findings in clinical practice.Material and methods. The study included CTA images of the abdomen of 130 patients, and their threedimensional models. A hardware-software complex "Luch-S" and software complex "Avtoplan" (Russian project) were used to perform morphometric analysis. The diameter of the renal artery mouth, the level of origin of the renal artery mouths, as well as the angles between the renal arteries and the abdominal aorta were analyzed morphometrically and statistically.Results. The authors have developed recommendations how to use three-dimensional modeling of vascular- organ complexes in patients at the stage of preoperative planning and intraoperative navigation in clinical practice. Generated dataset of personalized morphometric data can be applied to teach basic operation techniques involving possible damage to abnormal vessels, as well as training specific surgical procedures involving the kidney and its vessels in a simulation-based surgical clinic.

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