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Histopathology and Imaging

Histological Features of Giant Cell Arteritis

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Large and Medium Size Vessel and Single Organ Vasculitis

Part of the book series: Rare Diseases of the Immune System ((RDIS))

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Abstract

The gold standard to diagnose giant cell arteritis is temporal artery biopsy. The classical histologic picture of GCA is a transmural inflammatory infiltrate comprising lymphocytes, macrophages and, in about 50% of cases, giant cells. However, in some patients the inflammation may be restricted to the adventitial layer, to the vasa vasorum, or to the small vessels that surround the temporal artery.

Imaging techniques play a pivotal role both in the diagnosis and in the follow-up of patients with giant cell arteritis. According to the recommendations by the European League Against Rheumatism, imaging procedures should be the first diagnostic test, while temporal artery biopsy should be performed when imaging findings are not contributory. Color Doppler sonography is the modality of choice to image the temporal arteries: inflamed arteries typically show a positive “halo sign,” i.e., a hypoechoic (dark) halo around the temporal artery lumen. Color Doppler sonography can also be used to examine the superficial large vessels and to define whether there are lumen changes such as stenoses or aneurysms. Deep, large vessels such as the aorta are best imaged by computerized tomography or magnetic resonance imaging: signs of vasculitis are increased thickness of the vessel wall with enhancement. 18F-Fluorodeoxyglucose positron emission tomography can also be used to demonstrate arterial inflammation. 18F-Fluorodeoxyglucose positron emission tomography can visualize all large vessels and is very sensitive: a vascular smooth, linear pattern with Fluorodeoxyglucose uptake that affects long segments of the arteries is consistent with vasculitis. Imaging changes tend to improve or resolve the following treatment.

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Authors and Affiliations

  1. Arcispedale Santa Maria Nuova, Reggio Emilia, Italy

    Nicolò Pipitone

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  1. Nicolò Pipitone
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Correspondence to Nicolò Pipitone .

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Editors and Affiliations

  1. Rheumatology Unit, Azienda Unita’ Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Carlo Salvarani

  2. Rheumatology Unit, Azienda Unita’ Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Luigi Boiardi

  3. Rheumatology Unit, Azienda Unita’ Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Francesco Muratore

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Pipitone, N. (2021). Histopathology and Imaging. In: Salvarani, C., Boiardi, L., Muratore, F. (eds) Large and Medium Size Vessel and Single Organ Vasculitis. Rare Diseases of the Immune System. Springer, Cham. https://doi.org/10.1007/978-3-030-67175-4_5

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  • DOI: https://doi.org/10.1007/978-3-030-67175-4_5

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