Abstract
Giant cell arteritis (GCA) is the most common form of large vessel vasculitis. GCA is a medical and ophthalmological emergency, and rapid diagnosis and treatment with high-dose corticosteroids is critical in order to reduce the risk of stroke and sudden irreversible loss of vision. GCA can be difficult to diagnose due to insidious and unspecific symptoms—especially if typical superficial extracranial arteries are not affected. In these cases, verification of clinical diagnosis using temporal artery biopsy is not possible. This example illustrates the diagnostic value of hybrid imaging with 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT), and the limitations of the temporal artery biopsy in bilateral vertebral GCA, causing transient ischemic attack in the visual cortex. In addition it indicates that inflammation in the artery wall can be visualized on 2-[18F]FDG PET/CT despite long term and ongoing high dose glucocorticoid treatment.
Highlights
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Ultrasound of extracranial arteries shows good diagnostic performance; one limitation is assessment of the vertebral artery, in which diagnostic criteria such as halo sign and compressibility cannot be assessed and flow disturbances are unspecific, as these may be caused by atherosclerosis. 2-[18F]FDG PET enables whole body visualization of artery inflammation but is limited by price and accessibility
In studies using 2-[18F]FDG PET as a first-line imaging modality for Giant cell arteritis (GCA) the sensitivity was 92% and specificity was 85% compared to TAB [5]
Summary
Received: 22 April 2021 Accepted: 11 May 2021 Published: 14 May 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. BBialsiteydoofnctrhaeninailtianlvcolilnviecmaleansts.eTssrmeaetnmt,etnhtewrhitehumpraetdonloigsoisltosnuesp30ecmtedg ppoelrydmayyalwgiaasrhineiutimataetdican(PdMaRt)emwipthoraaloawrteprryobbaiboiplisty (oTfAcrBa)nwiaalsinrevqoulveesmtedenatl.oTnrgeawtmithenatnwopiththparelmdnoilsoogliocnalec3o0nsmugltapteiornd.aFyouwradsaiynsitilaterdtahnedopahttehmaplmoroalol gairstterfoyubnidopnsoy e(xTpAlBa-) wnaatsiorneqtouetshteedviasluoanlgsywmitphtoamn sopahntdhnalomsoiglongsiocaf lrceotinnsaul lotartoiopnti.cFnoeurrvedaisycshleamteira.thAesotphhetrheatlimnaollaongdistopfotuicnndenrvoeeaxspsleasnsamtieonnt wtoatshue nvriesmuaalrskyamblpe,tothmesoapnhdthnaolmsioglnosgiosft rseutsinpaelctoerdoaptriectrnoercvheiaissmchaelmpiaat.hAolsogthyeorfeatintraalnasniednot/pintitcernmeritvteenatssneastsumree.nItnwthaes smuengtrtiepnmegraordkfaaPybMlreeR,stuthhleteionopgphhitnhthaaalmldmeocolroleogagissyet csiuonnsCpsueRclPtteradaniasderdmettrahorekcehsduiassspymimcaipol nptoaomtfhoGreloCligAeyf.aoTnfhdaetirnTacAnreBsiaersneetsd/uitlnht teceardmmoesitatbgeanectkonfsaphturoerwde.innIingsotulhonensespeettoctiinf7ig5c ionffPlaMmRmtahteioonphinthtahlemionliotigayl cinocnissuioltnrsaoisfetdhtehteesmupspoircailonarotefrGy.CIAn athned minocrreeapserdoftohuenddoisnacgiesioofnpsroefdnthiseoalornteerytoa75wmelgl-dpeefrindeady arerseualtwinitghina atrdanecsmreuasrealininCflRamP manadtiomnarekmeedrgsyemd pintovmolvrienlgiefa.dTvheentTiAtiaB mreesduilat caanmdeinbtaicmkas.hAowcoinmgbuinnastpioecnifiocf ilnyflmapmhmocayttieosn, nineuthtreopinhiitlisa,leionsciinsoiopnhsilos fanthdeetpeimthpeloiroaidl ahritsetrioyc. YItnesthweerme oprreespernotf.oTuhnedinitnecrinsaiol nelsasotficthlaemairntaerwyaas wdeegllr-addeefidn.eNdoacroenavwinicthinga itnradnicsamtiuornaloifngfliamntmcealtlisown eerme edregteedcteindv.
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