Skip to main content

Advertisement

SpringerLink
Log in

The value of ultrasound in diagnosing extracranial large-vessel vasculitis compared to FDG-PET/CT: A retrospective study

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Large-vessel vasculitis (LVV) is a group of diseases mainly comprised of giant-cell arteritis (GCA), Takayasu arteritis, and a series of rare diseases like Behçet’s disease, IgG4-related disease, infectious aortitis, and other unfrequent entities. Besides clinical and laboratory features, Doppler sonography (DS) can assist in establishing the diagnosis. Its diagnostic sensitivity has been evaluated in various studies, most of them, however, in temporal arteritis (TA) respectively in LVV with involvement of the temporal artery. Little is known in extracranial LVV. We retrospectively evaluated the diagnostic accuracy of DS in 30 patients with extracranial, non-temporal LVV using the highly sensitive PET/CT as method of reference in comparison to 20 controls who were found to have no LVV. We investigated ten arterial sites and documented the presence of the sonographic halo sign. Sensitivities of DS for LVV were highest in the subclavian and axillary arteries (71.4%/72.2%) and low in the abdominal aorta (26.1%) and the common femoral artery (16.7%). DS detected 24 out of 30 cases of LVV (overall sensitivity 80.0%). The LVV cases where DS was completely negative did not significantly differ in leukocyte count, C-reactive protein, or erythrocyte sedimentation rate from LVV cases with positive DS. DS is a potent method in diagnosing extracranial LVV especially in the axillary and the subclavian arteries. Aortic, intraabdominal, and lower extremity artery manifestations, however, are often missed by DS. A second imaging modality (e.g., PET/CT) is therefore required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Weyand CM, Goronzy JJ (2003) Giant-cell arteritis and polymyalgia rheumatica. Ann Intern Med 139:505–515

    Article  PubMed  Google Scholar 

  2. Calamia KT, Schirmer M, Melikoglu M (2011) Major vessel involvement in Behçet’s disease: an update. Curr Opin Rheumatol 23:24–31. doi:10.1097/BOR.0b013e3283410088

    Article  PubMed  Google Scholar 

  3. Löffler C, Hoffend J, Rebel M et al (2016) A rare cause for lower back pain: a case of an IgG4-related periaortitis. Clin Rheumatol 35:265–270. doi:10.1007/s10067-014-2535-0

    Article  PubMed  Google Scholar 

  4. Haynes BF, Kaiser-Kupfer MI, Mason P, Fauci AS (1980) Cogan syndrome: studies in thirteen patients, long-term follow-up, and a review of the literature. Medicine (Baltimore) 59:426–441

    Article  CAS  Google Scholar 

  5. Schmidt WA, Kraft HE, Vorpahl K et al (1997) Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med 337:1336–1342

    Article  CAS  PubMed  Google Scholar 

  6. Karassa FB, Matsagas MI, Schmidt WA, Ioannidis JPA (2005) Meta-analysis: test performance of ultrasonography for giant-cell arteritis. Ann Intern Med 142:359–369

    Article  PubMed  Google Scholar 

  7. Arida A, Kyprianou M, Kanakis M, Sfikakis PP (2010) The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskelet Disord 11:44. doi:10.1186/1471-2474-11-44

    Article  PubMed  PubMed Central  Google Scholar 

  8. Maldini C, Dépinay-Dhellemmes C, Tra TTS et al (2010) Limited value of temporal artery ultrasonography examinations for diagnosis of giant cell arteritis: analysis of 77 subjects. J Rheumatol 37:2326–2330. doi:10.3899/jrheum.100353

    Article  PubMed  Google Scholar 

  9. Salvarani C, Silingardi M, Ghirarduzzi A et al (2002) Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis? Ann Intern Med 137:232–238

    Article  PubMed  Google Scholar 

  10. Förster S, Tato F, Weiss M et al (2011) Patterns of extracranial involvement in newly diagnosed giant cell arteritis assessed by physical examination, colour coded duplex sonography and FDG-PET. Vasa 40:219–227. doi:10.1024/0301-1526/a000096

    Article  PubMed  Google Scholar 

  11. Aschwanden M, Kesten F, Stern M et al (2010) Vascular involvement in patients with giant cell arteritis determined by duplex sonography of 2 × 11 arterial regions. Ann Rheum Dis 69:1356–1359. doi:10.1136/ard.2009.122135

    Article  PubMed  Google Scholar 

  12. Diamantopoulos AP, Haugeberg G, Hetland H et al (2014) Diagnostic value of color Doppler ultrasonography of temporal arteries and large vessels in giant cell arteritis: a consecutive case series. Arthritis Care Res 66:113–119. doi:10.1002/acr.22178

    Article  Google Scholar 

  13. Brodmann M, Lipp RW, Passath A et al (2004) The role of 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries. Rheumatology 43:241–242. doi:10.1093/rheumatology/keh025

    Article  CAS  PubMed  Google Scholar 

  14. Henes JC, Müller M, Krieger J et al (2008) [18F] FDG-PET/CT as a new and sensitive imaging method for the diagnosis of large vessel vasculitis. Clin Exp Rheumatol 26:47–52

    Google Scholar 

  15. Prieto-González S, Depetris M, García-Martínez A et al (2014) Positron emission tomography assessment of large vessel inflammation in patients with newly diagnosed, biopsy-proven giant cell arteritis: a prospective, case-control study. Ann Rheum Dis 73:1388–1392. doi:10.1136/annrheumdis-2013-204572

    Article  PubMed  Google Scholar 

  16. Meller J, Strutz F, Siefker U et al (2003) Early diagnosis and follow-up of aortitis with [(18)F]FDG PET and MRI. Eur J Nucl Med Mol Imaging 30:730–736. doi:10.1007/s00259-003-1144-y

    Article  CAS  PubMed  Google Scholar 

  17. Belhocine T, Blockmans D, Hustinx R et al (2003) Imaging of large vessel vasculitis with 18FDG PET: illusion or reality? A critical review of the literature data. Eur J Nucl Med Mol Imaging 30:1305–1313. doi:10.1007/s00259-003-1209-y

    Article  PubMed  Google Scholar 

  18. Hara M, Goodman PC, Leder RA (1999) FDG-PET finding in early-phase Takayasu arteritis. J Comput Assist Tomogr 23:16–18

    Article  CAS  PubMed  Google Scholar 

  19. Meller J, Grabbe E, Becker W, Vosshenrich R (2003) Value of F-18 FDG hybrid camera PET and MRI in early Takayasu aortitis. Eur Radiol 13:400–405. doi:10.1007/s00330-002-1518-8

    CAS  PubMed  Google Scholar 

  20. Hautzel H, Sander O, Heinzel A et al (2008) Assessment of large-vessel involvement in giant cell arteritis with 18F-FDG PET: introducing an ROC-analysis-based cutoff ratio. J Nucl Med 49:1107–1113. doi:10.2967/jnumed.108.051920

    Article  PubMed  Google Scholar 

  21. Puppo C, Massollo M, Paparo F et al (2014) Giant cell arteritis: a systematic review of the qualitative and semiquantitative methods to assess vasculitis with 18F-fluorodeoxyglucose positron emission tomography. Biomed Res Int 2014:574248. doi:10.1155/2014/574248

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hunder GG (1990) Giant cell (temporal) arteritis. Rheum Dis Clin N Am 16:399–409

    CAS  Google Scholar 

  23. Jennette JC, Falk RJ, Bacon PA et al (2012) 2012 Revised international Chapel Hill consensus conference nomenclature of vasculitides. Theol Rev 20:5–15. doi:10.1002/art.37715

    Google Scholar 

  24. Gonzalez-Gay MA, Garcia-Porrua C, Llorca J et al (2001) Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy. Semin Arthritis Rheum 30:249–256. doi:10.1053/sarh.2001.16650

    Article  CAS  PubMed  Google Scholar 

  25. Czihal M, Zanker S, Rademacher A et al (2012) Sonographic and clinical pattern of extracranial and cranial giant cell arteritis. Scand J Rheumatol 41:231–236. doi:10.3109/03009742.2011.641581

    Article  CAS  PubMed  Google Scholar 

  26. Lie JT (1995) Aortic and extracranial large vessel giant cell arteritis: a review of 72 cases with histopathologic documentation. Semin Arthritis Rheum 24:422–431

    Article  CAS  PubMed  Google Scholar 

  27. Klein RG, Hunder GG, Stanson AW, Sheps SG (1975) Large artery involvement in giant cell (temporal) arteritis. Ann Intern Med 83:806–812

    Article  CAS  PubMed  Google Scholar 

  28. Cavazza A, Muratore F, Boiardi L et al (2014) Inflamed temporal artery: histologic findings in 354 biopsies, with clinical correlations. Am J Surg Pathol 38:1360–1370

    Article  PubMed  Google Scholar 

  29. Muratore F, Boiardi L, Restuccia G et al (2013) Comparison between colour duplex sonography findings and different histological patterns of temporal artery. Rheumatology (Oxford) 52:2268–2274

    Article  Google Scholar 

  30. Schmidt D, Hetzel A, Reinhard M, Auw-Haedrich C (2003) Comparison between color duplex ultrasonography and histology of the temporal artery in cranial arteritis (giant cell arteritis). Eur J Med Res 8:1–7

    PubMed  Google Scholar 

Download references

Acknowledgements

We thank Dr. Uta Löffler for her assistance and aid in the statistical analyses.

Author information

Authors and Affiliations

  1. Department of Nephrology, Hypertensiology, Rheumatology, University Hospital Mannheim, University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany

    Christian Löffler, Urs Benck & Bernhard K. Krämer

  2. Department of Diagnostic and Interventional Radiology, Klinikum Ludwigshafen, Bremserstr. 79, D-67065, Ludwigshafen, Germany

    Johannes Hoffend

  3. Department of Rheumatology, Nephrology, Oncology, Klinikum Ludwigshafen, Bremserstr. 79, D-67065, Ludwigshafen, Germany

    Raoul Bergner

Authors
  1. Christian Löffler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johannes Hoffend
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Urs Benck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernhard K. Krämer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raoul Bergner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Löffler.

Ethics declarations

Disclosures

None.

Funding

No funding was involved in this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Löffler, C., Hoffend, J., Benck, U. et al. The value of ultrasound in diagnosing extracranial large-vessel vasculitis compared to FDG-PET/CT: A retrospective study. Clin Rheumatol 36, 2079–2086 (2017). https://doi.org/10.1007/s10067-017-3669-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-017-3669-7

Keywords

Search

Navigation