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

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

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

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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

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Acknowledgements

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

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France

    Pierre Emmanuel Berthod, Olivier Chevallier, Frédéric Ricolfi & Romaric Loffroy

  2. Department of Epidemiology and Biostatistics, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France

    Serge Aho-Glélé

  3. Department of Rheumatology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France

    Paul Ornetti

  4. Department of Internal Medicine and Systemic Diseases, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France

    Hervé Devilliers

  5. Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France

    Bernard Bonnotte & Maxime Samson

  6. 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

Authors
  1. Pierre Emmanuel Berthod
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  2. Serge Aho-Glélé
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  6. Frédéric Ricolfi
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  7. Bernard Bonnotte
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  8. Romaric Loffroy
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  9. Maxime Samson
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Corresponding author

Correspondence to Romaric Loffroy.

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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

Additional information

Romaric Loffroy and Maxime Samson both authors share the seniorship for this work

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Berthod, P.E., Aho-Glélé, S., Ornetti, P. et al. CT analysis of the aorta in giant-cell arteritis: a case-control study. Eur Radiol 28, 3676–3684 (2018). https://doi.org/10.1007/s00330-018-5311-8

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  • DOI: https://doi.org/10.1007/s00330-018-5311-8

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