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

Pierre Emmanuel Berthod (1, 2) , Serge Aho-Glélé (3) , Paul Ornetti (4) , Olivier Chevallier (2, 1) , Hervé Devilliers (5, 6) , Fréderic Ricolfi (7, 1) , Bernard Bonnotte (8) , Romaric Loffroy (9, 10, 1) , Maxime Samson (8)

1 Department vascular, oncologic ans interventional radiology (CHU de Dijon)
2 Service de radiologie et d'Imagerie médicale diagnostique et thérapeutique (CHU de Dijon)
3 DIM - Service Biostatistiques et Informatique Médicale (CHU de Dijon)
4 Service de Rhumatologie (CHU de Dijon)
5 Service de Médecine Interne (SOC 1 et SOC 2) [CHU de Dijon]
6 Service de médecine interne et maladies systémiques (SOC 2) [CHU de Dijon]
7 Service de neuroradiologie, imagerie des urgences [CHU de Dijon]
8 Service de médecine interne et immunologie clinique (SOC 1) [CHU de Dijon]
9 The Johns Hopkins University School of Medicine
10 Le2i - Laboratoire d'Electronique, d'Informatique et d'Image [EA 7508]

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. 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. 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%). 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. aEuro cent Imaging, including CT scan, plays an increasing role in GCA diagnosis aEuro cent CT measurement of aortic wall thickness is useful to diagnose GCA aEuro cent A 2.2-mm threshold allows the diagnosis of thickened aortic wall in GCA.

Mots clés: Giant cell aortitis; Arteritis; Thoracic aorta; Atherosclerosis; CT angiography Term-Follow-Up; Cardiovascular-Disease; Polymyalgia-Rheumatica; Temporal Arteritis; Involvement; Aortitis; Risk; Classification; Inflammation

Domaines: Imagerie; Ingénierie biomédicale; Médecine nucléaire; Imagerie médicale

Pierre Emmanuel Berthod, Serge Aho-Glélé, Paul Ornetti, Olivier Chevallier, Hervé Devilliers, et al.. CT analysis of the aorta in giant-cell arteritis: a case-control study. European Radiology, 2018, 28 (9), pp.3676 - 3684. ⟨10.1007/s00330-018-5311-8⟩. ⟨hal-01861265⟩