Abdominal aortic involvement in active giant cell (temporal) arteritis: a study of 20 patients by Doppler ultrasonography and computed tomographic angiography

摘要

OBJECTIVE: This study used Doppler ultrasonography and computed tomographic angiography (CTA) to assess the prevalence of abdominal aortic lesions that suggested abdominal aortitis at diagnosis of giant-cell or temporal arteritis (GCA). We also evaluated the contribution of these 2 techniques to diagnosis. METHODS: This single-center study included patients admitted to the internal medicine department of the Nantes (France) University Hospital, between May 1999 and May 2002 at the time of their diagnosis with biopsy-proven GCA. In the 8 weeks after diagnosis, patients underwent a thorough workup, including the collection of clinical and laboratory data. Imaging tests for each patient included Doppler ultrasonography and a CTA scan of the abdominal aorta, looking for aneurysms, ectasia, and thickening of the aortic wall. RESULTS: This study included 20 patients (17 women, mean age 73.9+/-7.2 years, mean CRP=116+/-75.9mg/L). Doppler ultrasonography suggested aortitis in 8 cases (40%): 7 patients (35%) had a hypoechoic halo, 3 (15%) a small aneurysm (diameter < 30mm), and 2 (10%) both. CTA scans of the aorta showed aortitis in 5 cases (25%), all with abnormal thickening of the aortic wall. CTA did not identify any aneurysms. Overall, abdominal aortitis was suspected in 10 patients (50%). CONCLUSION: At the time of GCA diagnosis, both Doppler ultrasonography and CTA can detect morphological abnormalities of the abdominal aorta. Here they suggested asymptomatic abdominal aortitis in half the patients. Doppler ultrasonography appears more effective for detecting aortic aneurysms, while CTA seems helpful for the diagnosis of parietal thickening. The risk factors associated with abdominal aortitis in GCA remain to be identified.