European Radiology

, Volume 28, Issue 9, pp 3676–3684 | Cite as

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

  • Pierre Emmanuel Berthod
  • Serge Aho-Glélé
  • Paul Ornetti
  • Olivier Chevallier
  • Hervé Devilliers
  • Frédéric Ricolfi
  • Bernard Bonnotte
  • Romaric Loffroy
  • Maxime Samson



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.

Key points

Imaging, including CT scan, plays an increasing role in GCA diagnosis

CT measurement of aortic wall thickness is useful to diagnose GCA

A 2.2-mm threshold allows the diagnosis of thickened aortic wall in GCA


Giant cell aortitis Arteritis Thoracic aorta Atherosclerosis CT angiography 



American College of Rheumatology


C-reactive Protein


Erythrocyte Sedimentation Rate


European League Against Rheumatism


Giant Cell Arteritis


French Health Authority


Polymyalgia Rheumatic


Temporal Artery Biopsy



We thank P.B. for his help in revising the manuscript.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Romaric Loffroy.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors, Serge Aho-Glélé, has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• case-control study

• performed at one institution


  1. 1.
    Jennette JC, Falk RJ, Bacon PA et al (2013) Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65:1–11CrossRefPubMedGoogle Scholar
  2. 2.
    Salvarani C, Cantini F, Hunder GG (2008) Polymyalgia rheumatica and giant-cell arteritis. Lancet 372:234–245CrossRefPubMedGoogle Scholar
  3. 3.
    Hunder GG, Bloch DA, Michel BA et al (1990) The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 33:1122–1128CrossRefPubMedGoogle Scholar
  4. 4.
    Stone JH, Tuckwell K, Dimonaco S et al (2017) Trial of tocilizumab in giant-cell arteritis. N Engl J Med 377:317–328CrossRefPubMedGoogle Scholar
  5. 5.
    Mekinian A, Djelbani S, Viry F, Fain O, Soussan M (2016) Usefulness of imaging in large vessel vasculitis. Rev Med Interne 37:245–255CrossRefPubMedGoogle Scholar
  6. 6.
    Prieto-González S, Espígol-Frigolé G, García-Martínez A et al (2016) The Expanding role of imaging in systemic vasculitis. Rheum Dis Clin N Am 42:733–751CrossRefGoogle Scholar
  7. 7.
    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 73:1388–1392CrossRefPubMedGoogle Scholar
  8. 8.
    Gornik HL, Creager MA (2008) Aortitis. Circulation 117:3039–3051CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Foote EA, Postier RG, Greenfield RA, Bronze MS (2005) Infectious aortitis. Curr Treat Options Cardiovasc Med 7:89–97CrossRefPubMedGoogle Scholar
  10. 10.
    Caspary L (2016) Inflammatory diseases of the aorta. VASA 45:17–29CrossRefPubMedGoogle Scholar
  11. 11.
    Espitia O, Samson M, Le Gallou T et al (2016) Comparison of idiopathic (isolated) aortitis and giant cell arteritis-related aortitis. A French retrospective multicenter study of 117 patients. Autoimmun Rev 15:571–576CrossRefPubMedGoogle Scholar
  12. 12.
    Klein RG, Hunder GG, Stanson AW, Sheps SG (1975) Large artery involvement in giant cell (temporal) arteritis. Ann Intern Med 83:806–812CrossRefPubMedGoogle Scholar
  13. 13.
    Prieto-González S, Arguis P, García-Martínez A et al (2012) Large vessel involvement in biopsy-proven giant cell arteritis: prospective study in 40 newly diagnosed patients using CT angiography. Ann Rheum Dis 71:1170–1176CrossRefPubMedGoogle Scholar
  14. 14.
    Marie I, Proux A, Duhaut P et al (2009) Long-term follow-up of aortic involvement in giant cell arteritis: a series of 48 patients. Medicine (Baltimore) 88:182–192CrossRefGoogle Scholar
  15. 15.
    Agard C, Barrier J-H, Dupas B et al (2008) Aortic involvement in recent-onset giant cell (temporal) arteritis: a case-control prospective study using helical aortic computed tomodensitometric scan. Arthritis Rheum 59:670–676CrossRefPubMedGoogle Scholar
  16. 16.
    Espitia O, Agard C (2013) Aortitis in giant cell arteritis and its complications. Rev Med Interne 34:412–420CrossRefPubMedGoogle Scholar
  17. 17.
    Hervé F, Choussy V, Janvresse A, Cailleux N, Levesque H, Marie I (2006) Aortic involvement in giant cell arteritis. A prospective follow-up of 11 patients using computed tomography. Rev Med Interne 27:196–202CrossRefPubMedGoogle Scholar
  18. 18.
    Prieto-González S, García-Martínez A, Tavera-Bahillo I et al (2015) Effect of glucocorticoid treatment on computed tomography angiography detected large-vessel inflammation in giant-cell arteritis. A prospective, longitudinal study. Medicine (Baltimore) 94:e486CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Dasgupta B, Cimmino MA, Kremers HM et al (2012) Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum 64:943–954CrossRefPubMedGoogle Scholar
  20. 20.
    Haute Autorité de Santé (2017) Principales dyslipidémies : stratégies de prise en charge. Available from:
  21. 21.
    Haute Autorité de Santé (2017) Guide parcours de soins: diabète de type 2 de l’adulte. Available from:
  22. 22.
    García-Martínez A, Hernández-Rodríguez J, Arguis P et al (2008) Development of aortic aneurysm/dilatation during the followup of patients with giant cell arteritis: a cross-sectional screening of fifty-four prospectively followed patients. Arthritis Rheum 59:422–430CrossRefPubMedGoogle Scholar
  23. 23.
    Mahmood SS, Levy D, Vasan RS, Wang TJ (2014) The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet 383:999–1008CrossRefPubMedGoogle Scholar
  24. 24.
    Blomberg BA, de Jong PA, Thomassen A et al (2017) Thoracic aorta calcification but not inflammation is associated with increased cardiovascular disease risk: results of the CAMONA study. Eur J Nucl Med Mol Imaging 44:249–258CrossRefPubMedGoogle Scholar
  25. 25.
    Rodríguez-Palomares JF, Evangelista Masip A (2016) Aortic calcium score and vascular atherosclerosis in asymptomatic individuals: beyond the coronary arteries. Rev Esp Cardiol (Engl Ed) 69:813–816CrossRefGoogle Scholar
  26. 26.
    Craiem D, Chironi G, Casciaro ME, Graf S, Simon A (2014) Calcifications of the thoracic aorta on extended non-contrast-enhanced cardiac CT. PLoS One 9:e109584CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Karim R, Hodis HN, Detrano R, Liu C-R, Liu C-H, Mack WJ (2008) Relation of Framingham risk score to subclinical atherosclerosis evaluated across three arterial sites. Am J Cardiol 102:825–830CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Samson M, Jacquin A, Audia S et al (2015) Stroke associated with giant cell arteritis: a population-based study. J Neurol Neurosurg Psychiatry 86:216–221CrossRefPubMedGoogle Scholar
  29. 29.
    Tomasson G, Peloquin C, Mohammad A et al (2014) Risk for cardiovascular disease early and late after a diagnosis of giant-cell arteritis: a cohort study. Ann Intern Med 160:73–80CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Gonzalez-Gay MA, Garcia-Porrua C, Piñeiro A, Pego-Reigosa R, Llorca J, Hunder GG (2004) Aortic aneurysm and dissection in patients with biopsy-proven giant cell arteritis from northwestern Spain: a population-based study. Medicine (Baltimore) 83:335–341CrossRefGoogle Scholar
  31. 31.
    García-Martínez A, Arguis P, Prieto-González S et al (2014) Prospective long term follow-up of a cohort of patients with giant cell arteritis screened for aortic structural damage (aneurysm or dilatation). Ann Rheum Dis 73:1826–1832CrossRefPubMedGoogle Scholar
  32. 32.
    Hommada M, Mekinian A, Brillet PY et al (2017) Aortitis in giant cell arteritis: diagnosis with FDG PET/CT and agreement with CT angiography. Autoimmun Rev 16:1131–1137CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Pierre Emmanuel Berthod
    • 1
  • Serge Aho-Glélé
    • 2
  • Paul Ornetti
    • 3
  • Olivier Chevallier
    • 1
  • Hervé Devilliers
    • 4
  • Frédéric Ricolfi
    • 1
  • Bernard Bonnotte
    • 5
  • Romaric Loffroy
    • 1
    • 6
  • Maxime Samson
    • 5
  1. 1.Department of Vascular and Interventional Radiology, François-Mitterrand Teaching HospitalUniversity of Bourgogne-Franche-ComtéDijonFrance
  2. 2.Department of Epidemiology and Biostatistics, François-Mitterrand Teaching HospitalUniversity of Bourgogne-Franche-ComtéDijonFrance
  3. 3.Department of Rheumatology, François-Mitterrand Teaching HospitalUniversity of Bourgogne-Franche-ComtéDijonFrance
  4. 4.Department of Internal Medicine and Systemic Diseases, François-Mitterrand Teaching HospitalUniversity of Bourgogne-Franche-ComtéDijonFrance
  5. 5.Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching HospitalUniversity of Bourgogne-Franche-ComtéDijonFrance
  6. 6.Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et MétiersUniversity of Bourgogne-Franche-ComtéDijon CedexFrance

Personalised recommendations