Hospital General Universitario Gregorio Marañón Madrid, Spain
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Juan Molina-Collada1, Isabel Castrejon2, Irene Monjo3, Elisa Fernandez-Fernandez4, Gabriela Torres5, JULIA MARTINEZ BARRIO6, Jose María Alvaro-Gracias7 and Eugenio De Miguel5, 1Hospital General Universitario Gregorio Marañón, Madrid, Spain, 2Hospital Universitario Gregorio Marañón, Madrid, Spain, 3University Hospital La Paz, Madrid, Spain, 4La Paz University Hospital, Madrid, Spain, 5Hospital Universitario La Paz, Madrid, Spain, 6Rheumatology, Gregorio Marañon University Hospital, Madrid, Spain, 7Hospital General Universitario Gregorio Marañon, Madrid, Spain
Background/Purpose: Aortitis is a serious potential complication of patients with giant cell arteritis (GCA) and may lead to dilation, aneurysms or dissection. Since ultrasound (US) has limited access to detect aortitis, comparative studies with other imaging modalities to determine the clinical impact of this limitation and the specific situations warranting their use are needed. Our aim was to determine the impact of US intrinsic limitation to assess aortitis vs FDG-PET/CT in patients with US-proven GCA and to identify factors associated with aortic involvement.
Methods: Retrospective observational study of patients referred to US fast-track clinics at two academic centres over a four-year period. Only patients with GCA confirmed by US were included. Temporal (TA) and extracranial arteries US were performed at baseline. FDG-PET/CT was performed according to clinician's criteria. An FDG artery uptake at the aorta higher than liver uptake was considered positive for aortitis.
Results: Seventy-two of 186 patients with US-proven GCA underwent an FDG-PET/CT; 29 (40.3%) had a positive FDG-PET/CT and 24 (33.3%) presented aortitis. Only 6 (20.7%) patients with positive FDG-PET/CT had negative US findings of large vessel (LV)-GCA. Among patients with aortitis in FDG-PET/CT, only 2 (8.3%) had negative US findings of LV-GCA. Patients with aortitis were younger (68.9 vs 81;p< 0.001), more frequently females (79.2% vs 39.6%;p=0.002) and had higher platelets count (413.4 vs 311.1;p=0014) (Table 1). Patients with aortitis presented positive TA US less frequently (41.7% vs 83.3%;p< 0.001), but more LV US involvement (91.7% vs 41.7%; p< 0.001) versus patients without aortitis (Table 2). None of the patients with aortitis exhibited visual symptoms (0% vs31.2%;p=0.001).
Conclusion: FDG-PET/CT can detect aortitis in 1 out of every 3 patients with US-proven GCA. However, a negative US examination for LV-GCA suggests a low risk of aortitis. Younger and female GCA patients with thrombocytosis, absence of visual manifestations and LV-GCA on US may more frequently present aortitis by FDG-PET/CT.
Table 1. Clinical, laboratory and histology findings of patients with and without aortic involvement.
Table 2. US patterns of vascular involvement in patients with or without aortitis in FDG-PET/CT.
J. Molina-Collada: None; I. Castrejon: Bristol Myers Squibb, 1, 6, Galapagos, 2, GlaxoSmithKline, 1, 6, Lilly, 1, 6, Merck Sharp & Dohme, 6, Pfizer, 1, 2, 6; I. Monjo: Amgen, 6, Gedeon Richter, 6, Janssen, 6, Novartis, 6, Roche, 6, UCB, 6; E. Fernandez-Fernandez: None; G. Torres: None; J. MARTINEZ BARRIO: None; J. Alvaro-Gracias: Abbvie, 2, 6, AstraZeneca, 2, 6, Eli Lilly, 2, 6, Galapagos, 2, 6, Gilead, 2, 6, GSK, 2, 6, Merck/MSD, 2, 6, Novartis, 2, 6, Pfizer, 2, 6, UCB, 2, 6; E. De Miguel: None.
