Ultrasonographic findings as diagnostic and follow-up tool in cranial giant cell arteritis
Ultrasonographic findings as diagnostic and follow-up tool in cranial giant cell arteritis
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超声检查结果作为颅巨细胞动脉炎的诊断和随访工具
DOI：
10.1093/qjmed/hcx174
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Terada Y
中科院分区：
文献类型：
--
作者：
Taniguchi Y;Nishikawa H;Amano E;Fujimoto S;Terada Y
一位79岁的男性，有三周的发热史，视力快速进行性下降，下颌跛行。生化分析显示C反应蛋白（CRP）水平升高（120 mg/L;正常< 3）和红细胞沉降率（ESR）水平升高（140 mm/h;正常< 10）;抗神经细胞胞浆抗体和抗核抗体检测结果为阴性。血培养呈阴性。肝肾功能正常。体格检查显示双侧颞动脉可触及且呈索状（图1A，箭头）。治疗前双侧颞动脉彩色多普勒超声（US）特征纵切面显示颞动脉低回声晕，存在湍流和弱流，因为存在对应于动脉壁水肿的晕征（图1B）。然后，左颞动脉活检显示了明显的颞动脉炎与巨细胞。患者被诊断为颅巨细胞动脉炎（GCA）。开始泼尼松龙治疗。经治疗后，患者的所有症状均消失，ESR和血清CRP水平恢复正常。他的双侧颞动脉可触及和索状的异常体格检查结果也得到改善（图1C）。同样，治疗后颞动脉彩色多普勒超声纵向视图显示晕轮征和湍流减少，血流比治疗前更强，对应于动脉壁水肿显著减少（图1D）。最近，高分辨率磁共振成像，1正电子发射断层扫描和计算机断层扫描血管造影2和彩色多普勒超声3的临床意义已经报道了GCA的诊断。在这种情况下，彩色多普勒超声不仅是非常有用的，在诊断颅GCA，但也有用的后续病人开始治疗后。本病例应提醒读者考虑彩色多普勒超声评估作为颅内GCA疾病活动的方便监测工具。
A 79-year-old man presented with a three-week history of fever, rapidly progressive declining visual acuity, and jaw claudication. The biochemical profile showed elevated levels of C-reactive protein (CRP)(120 mg/L; normal< 3) and an erythrocyte sedimentation rate (ESR)(140 mm/hour; normal< 10); results of testing for antineutrophil cytoplasmic antibodies and antinuclear antibody were negative. Blood cultures were negative. Hepatic and renal functions were normal. Physical examination showed palpable and funicular bilateral temporal arteries (Figure 1A, arrows). Longitudinal view of bilateral temporal arteries color Doppler ultrasonography (US) features before treatment showed a hypoechogenic halo of the temporal artery and the presence of turbulent flow and weak flow because of the presence of halo sign corresponding to edema of arterial wall (Figure 1B). Then, the biopsy of the left temporal artery demonstrated significant temporal arteritis with giant cells. The patient was diagnosed with cranial giant cell arteritis (GCA). Treatment with prednisolone was initiated. After treatment, his all symptoms resolved and ESR and serum CRP levels became normal. His abnormal physical finding of palpable and funicular bilateral temporal artery also improved (Figure 1C). Similarly, longitudinal view of temporal artery color Doppler US after treatment showed reduction of halo sign and turbulent flow and a stronger flow than before treatment that corresponds to a significant reduction of edema of artery wall (Figure 1D). Recently, the clinical implications of high-resolution magnetic resonance imaging, 1 Positron Emission Tomography and Computed Tomography Angiography2 and color Doppler ultrasonography3 have reported on diagnosis of GCA. In the present case, color Doppler US is not only very useful in the diagnosis of cranial GCA but also useful in following up of patients after initiation of therapy. This case should remind readers to consider the assessment by color Doppler US as convenient monitoring tool of disease activity in cranial GCA.