CT analysis of the aorta in giant-cell arteritis: a case-control study

  • Pierre Emmanuel Berthod
  • Serge Aho-Glélé
  • Paul Ornetti
  • Olivier Chevallier
  • Hervé Devilliers
  • Frédéric Ricolfi
  • Bernard Bonnotte
  • Romaric Loffroy
  • Maxime Samson
Vascular-Interventional
  • 43 Downloads

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

Keywords

Giant cell aortitis Arteritis Thoracic aorta Atherosclerosis CT angiography 

Abbreviations

ACR

American College of Rheumatology

CRP

C-reactive Protein

ESR

Erythrocyte Sedimentation Rate

EULAR

European League Against Rheumatism

GCA

Giant Cell Arteritis

HAS

French Health Authority

PMR

Polymyalgia Rheumatic

TAB

Temporal Artery Biopsy

Notes

Acknowledgements

We thank P.B. for his help in revising the manuscript.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Romaric Loffroy.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors, Serge Aho-Glélé, has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Pierre Emmanuel Berthod
    • 1
  • Serge Aho-Glélé
    • 2
  • Paul Ornetti
    • 3
  • Olivier Chevallier
    • 1
  • Hervé Devilliers
    • 4
  • Frédéric Ricolfi
    • 1
  • Bernard Bonnotte
    • 5
  • Romaric Loffroy
    • 1
    • 6
  • Maxime Samson
    • 5
  1. 1.Department of Vascular and Interventional Radiology, François-Mitterrand Teaching HospitalUniversity of Bourgogne-Franche-ComtéDijonFrance
  2. 2.Department of Epidemiology and Biostatistics, François-Mitterrand Teaching HospitalUniversity of Bourgogne-Franche-ComtéDijonFrance
  3. 3.Department of Rheumatology, François-Mitterrand Teaching HospitalUniversity of Bourgogne-Franche-ComtéDijonFrance
  4. 4.Department of Internal Medicine and Systemic Diseases, François-Mitterrand Teaching HospitalUniversity of Bourgogne-Franche-ComtéDijonFrance
  5. 5.Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching HospitalUniversity of Bourgogne-Franche-ComtéDijonFrance
  6. 6.Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et MétiersUniversity of Bourgogne-Franche-ComtéDijon CedexFrance

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