Effect of Glucocorticoid Treatment on Computed Tomography Angiography Detected Large-Vessel Inflammation in Giant-Cell Arteritis. A Prospective, Longitudinal Study
نویسندگان
چکیده
Computed tomography angiography (CTA) detects signs of large-vessel vasculitis (LVV) in about 67.5% of patients with giant-cell arteritis (GCA) at the time of diagnosis and early aortic dilatation in 15%. The outcome of CTA-findings of LVV upon glucocorticoid treatment has not been prospectively evaluated. The aim of our study was to prospectively assess glucocorticoid-induced changes in CTA findings of LVV in patients with GCA. Forty biopsy-proven GCA patients evaluated by CTA at diagnosis were prospectively followed and scheduled a new CTA approximately after 1 year of treatment. Vessel wall thickening, diameter, and contrast enhancement of the aorta and its tributaries were evaluated. Results were compared to those obtained at the time of diagnosis. CTA was repeated to 35 patients after a median follow-up of 13.5 months (IQ25-75% 12.4-15.8). Arterial wall thickening was still present in 17 patients (68% of the patients who initially had LVV). The number of affected segments and wall thickness at various aortic segments significantly decreased and no patients developed new lesions, new aortic dilation or increase in previous dilation. Contrast enhancement disappeared in 15 (93.75%) of 16 patients in whom this finding could be assessed. Signs of LVV improve with treatment. While contrast enhancement resolves in the majority of patients, vessel wall thickening persists in two thirds. However, the number of affected aortic segments as well as aortic wall thickness significantly decreases. Longer follow-up is necessary to determine the clinical significance of persisting wall thickening and its relationship with relapses or subsequent development of aortic dilatation or large-vessel stenoses.
منابع مشابه
Use of FDG-PET Scan for the Assessment of Large Vessel Vasculitis
Temporal artery biopsy will only detect (part of) the cranial forms of giant cell arteritis. For the large vessel variant of this type of vasculitis, FDG-PET is the technique of choice. Since treatment of large vessel vasculitis implies long-term treatment with steroids, it is important to have a firm diagnosis. I suggest performing a FDG-PET scan in every patient in whom large vessel vasculiti...
متن کاملSteroid-responsive large vessel vasculitis: application of whole-brain 320-detector row dynamic volume CT angiography and perfusion.
SUMMARY A patient with suspected giant cell arteritis and prior negative findings on superficial temporal artery biopsy was evaluated with 320-detector row CT angiography (CTA) and whole-brain perfusion. Corticosteroid treatment was initiated on the basis of CT angiography findings of arteritis and a cortical perfusion deficit. The patient's symptoms and perfusion imaging findings resolved foll...
متن کاملEarly improvement of radiological signs of large-vessel inflammation in giant cell arteritis upon glucocorticoid treatment.
متن کامل
A Rare Case of Paraneoplastic Aortitis Associated with Chronic Myelomonocytic Leukemia
Aortitis is a broad term describing inflammation of the aorta. The most common causes of aortitis are the large-vessel vasculitides giant cell arteritis and Takayasu arteritis. Other etiologies include aortitis associated with other autoimmune disorders, infectious causes, and paraneoplastic and idiopathic cases. We describe a rare case of a large-vessel arteritis occurring in association with ...
متن کاملMigratory large vessel vasculitis preceding acute myeloid leukemia: a case report
BACKGROUND Large vessel vasculitis is a rare disorder usually occurring in the context of the autoimmune conditions of giant cell arteritis and Takayasu's arteritis. Case reports have described large vessel vasculitis occurring in individuals with myelodysplastic syndrome, preceding transformation to acute myeloid leukemia. CASE PRESENTATION A 56-year-old Afghanistan-born woman presented with...
متن کامل