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CT angiography can show progress of treatment for giant-cell arteritis, large-vessel vasculitis
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CT angiography successfully showed improvements made by glucocorticoid treatment in patients with giant-cell arteritis who presented with large-vessel vasculitis, according to researchers from the University of Barcelona.
The researchers prospectively studied the outcomes of 35 patients approximately 1 year after they initiated glucocorticoid treatment for biopsy-confirmed diagnosis of giant-cell arteritis (GCA) with large-vessel vasculitis (LVV). Patients were evaluated using CT angiography at diagnosis and again at 1, 3, 6, 9 and 12 months, and details including cranial symptoms (headache, jaw claudication and scalp tenderness), polymyalgia rheumatica, fever or weight loss, disease-related cranial ischemic complications and the presence of claudication in the extremities were recorded. Laboratory evaluations included C-reactive protein, erythrocyte sedimentation rate and hemoglobin at each visit, and the intensity of the systemic inflammatory response, including fever, was monitored.
Vascular dilation or stenosis and vessel wall thickening was assessed at four aortic segments in each patient. Aortitis was defined as a thickening in the circumference of the aortic wall of 2 mm or more, and aortic dilation was defined as a diameter of 4 cm or greater in the ascending aorta, 4 cm or greater in the rest of the thoracic aorta, and 3 cm or greater in the abdominal aorta.
Abnormal CT angiography findings were seen in 19 patients. Significant aortic thickening was seen in 16 patients at baseline and at the aortic arch in 11 patients. Aortic branch inflammation was seen in 12 patients, and thickening was observed in nine patients in the abdominal aorta and in four patients at the ascending aorta.
After follow-up, vessel wall thickening was still present in 68% of the 25 patients who initially presented with the symptom on CT angiography. The number of vascular segments affected decreased, and reduction in mean thickness of the aortic wall was observed. Aortic diameter remained unchanged after follow-up, and no new aortic dilation was detected, according to the researchers. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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