Objectives: To evaluate MRI and FDG-PET regarding the diagnosis and disease activity of inflammatory aortic arch syndrome in patients with complicated giant cell arteritis.
Methods: MRI and FDG-PET were performed for 25 patients with giant cell arteritis who presented with a complicated disease course despite immunosuppressive therapy. Disease activity of the thoracic aorta and the supraaortic arteries as assessed by both modalities was compared to serological (CRP, ESR) and clinical findings (BVAS.2). Additionally, MRI was evaluated concerning assessment of vessel wall thickening, aneurysms, and stenoses.
Results: In 17 of 25 patients, MRI revealed structural vessel lesions suspicious for vasculitis. Active disease was detected by MRI, thoracic PET, and whole body PET in 22, 14, and 20 patients, respectively. While serological and clinical findings correlated significantly among each other, there was no concordance with MRI and only low, non-significant correlation of PET with CRP (rs= -0.158, 0.136), ESR (rs= -0.232, 0.320) and BVAS.2 (rs= -0.064, 0.221) regarding disease activity.
Conclusions: MRI and PET are unreliable for assessing large vessel inflammation in patients with giant cell arteritis and pre-existing immunosuppressive therapy. MRI is valuable for its ability to detect morphologic vessel lesions, such as aneurysms and stenoses.
- aortic arch syndrome
- giant cell arteritis
- magnetic resonance imaging
- positron emission tomography