20.500.12556/RUL-189827 Diagnostična vloga ultrazvočne preiskave kranialnih arterij in arterij aortnega loka pri gigantoceličnem arteritisu​ Diagnostic role of ultrasonography of cranial and aortic arch arteries in giant cell arteritis Ozadje: Pri sumu na gigantocelični arteritis (GCA) je za preprečitev trajnih ishemičnih zapletov ključnega pomena hiter in zanesljiv diagnostični postopek. Slikovne metode, zlasti ultrazvočna (UZ) preiskava arterij, zato postajajo vedno pomembnejše v diagnostiki GCA. UZ preiskava arterij zaenkrat temelji na kvalitativni interpretaciji izkušenega preiskovalca (prisotnost znaka halo), kar lahko omejuje širšo uporabnost preiskave. GCA poleg temporalnih lahko prizadene tudi druge kranialne arterije, podatkov o pogostnosti in kliničnih posledicah prizadetosti ostalih kranialnih arterij pa je razmeroma malo. Namen: Poglavitni namen dela je bil določiti mejno debelino žilne stene preiskovanih arterij, ki z visoko diagnostično natančnostjo razloči med bolniki z GCA in preiskovanci, pri katerih je ta bolezen malo verjetna. Dodatni namen dela je bil ugotoviti, ali je prizadetost facialnih in okcipitalnih arterij pri bolnikih z diagnozo GCA povezana s specifično klinično sliko. Materiali in metode: Šlo je za prospektivno opazovalno raziskavo, v katero smo vključevali zaporedne osebe, napotene na Klinični oddelek za revmatologijo Univerzitetnega kliničnega centra Ljubljana pod sumom na GCA. Pri preiskovancih smo sistematično zbrali demografske, klinične in laboratorijske podatke, opravili UZ preiskavo temporalnih in aksilarnih arterij (ki so vključene zadnja priporočila slikovne diagnostike pri GCA) ter petih dodatnih arterij (facialnih, okcipitalnih, skupnih karotidnih, vertebralnih in subklavijskih). Ob tem smo beležili prisotnost znaka halo ter maksimalno debelino kompleksa intima-medija na mestu brez evidentnih fokalnih zadebelitev oz. aterosklerotičnih plakov. Za določitev mejne debeline žilne stene smo primerjali debelino žilne stene prizadetih arterij pri bolnikih z GCA z debelino žilne stene pri preiskovancih iz kontrolne skupine. Rezultati: V 72-mesečnem opazovalnem obdobju od 1.10.2013 do 30.9.2019 smo med 349 pregledanimi osebami ugotovili 248 novih primerov GCA, 101 oseba je bila vključena v kontrolno skupino. Znak halo na katerikoli izmed pregledanih arterij smo našli pri 244 (98,4 %) bolnikih s klinično diagnozo GCA. Pri 23 (9,3 %) bolnikih z GCA smo znak halo ugotavljali izključno na (vsaj) eni izmed arterij, ki trenutno niso vključene v priporočila slikovne diagnostike pri GCA. Naslednje mejne vrednosti debeline kompleksa intima-medija so z visoko diagnostično natančnostjo razlikovale med vnetno zadebeljeno in nevneto žilno steno preiskovanih arterij: temporalne, facialne in okcipitalne arterije: ≥ 0,4 mm; skupne karotidne, subklavijske in aksilarne arterije: ≥ 1,0 mm; vertebralne arterije: ≥ 0,7 mm. Potrdili smo statistično značilno povezavo med prizadetostjo facialnih arterij in klavdikacijsko bolečino v žvečnih mišicah ter trajnimi motnjami vida. Zaključki: Pokazali smo, da preiskava več različnih arterij lahko izboljša diagnostično učinkovitost UZ preiskave pri bolnikih s sumom na GCA. Predlagane mejne vrednosti debeline kompleksa intima-medija so visoko občutljive in specifične. Prikazali smo statistično značilno povezanost med vaskulitično prizadetostjo facialnih arterij in značilnimi elementi klinične slike. Background: Rapid and reliable diagnostic procedure is crucial to prevent permanent ischemic complications in patients with suspected giant cell arteritis (GCA). Imaging methods, especially colour-Doppler sonography (CDS), are thus becoming increasingly important in the diagnosis of GCA. CDS examination is currently based on the qualitative interpretation of an experienced examiner (presence of a halo sign), which may limit its wider applicability. The data on the frequency and clinical consequences of involvement of cranial arteries other than temporal arteries are scarce. Objectives: The main objective of the study was to determine the cut-off thickness of the arterial wall of the examined arteries that distinguishes with high diagnostic accuracy between patients with GCA and persons in whom this disease is unlikely. An additional aim of the study was to determine whether involvement of the facial and occipital arteries is associated with specific clinical characteristics in patients diagnosed with GCA. Materials and methods: This prospective observational study included consecutive individuals referred to the Clinical Department of Rheumatology at the University Medical Centre Ljubljana due to suspected GCA. We systematically collected their demographic, clinical, and laboratory data, performed CDS of the temporal and axillary arteries (which are included in the latest recommendations for imaging diagnostics in GCA) and five additional paired arteries (facial, occipital, common carotid, vertebral, and subclavian). During the CDS examination, we recorded the presence of a halo sign and the maximum intima-media thickness at sites without evident focal thickening or atherosclerotic plaques. To determine the cut-off thickness of the vascular wall, we compared the thickness of the intima-media complex of affected arteries in patients with GCA with the thickness of the intima-media complex in subjects from the control group. Results: During the 72-month observation period from October 1, 2013, to September 30, 2019, we included 349 patients and identified 248 new cases of GCA; 101 individuals were included in the control group. The halo sign in any of the examined arteries was recorded in 244 (98.4%) patients with a clinical diagnosis of GCA. In 23 (9.3%) patients with GCA, we found the “halo” sign exclusively in (at least) one of the arteries not currently included in the diagnostic imaging recommendations for GCA. The following intima-media thickness cut-off values distinguished with high diagnostic accuracy between inflamed and non-inflamed vessel walls of the examined arteries: temporal, facial, and occipital arteries: ≥ 0.4 mm; common carotid, subclavian, and axillary arteries: ≥ 1.0 mm; vertebral arteries: ≥ 0.7 mm. We confirmed a statistically significant association between vasculitic facial artery involvement, jaw claudication and permanent visual disturbances. Conclusions: Examination of several different arteries can improve the diagnostic effectiveness of CDS in patients with suspected GCA. The proposed cut-off values for intima-media thickness are highly sensitive and specific. We demonstrated a statistically significant correlation between facial artery involvement and salient clinical characteristics of GCA. gigantocelični arteritis ultrazvočna preiskava vaskulitis giant cell arteritis ultrasonography vasculitis true false false Slovenski jezik Angleški jezik Doktorsko delo/naloga 2026-10-16 13:27:31 2026-10-16 13:27:45 2026-10-17 04:16:18 0000-00-00 00:00:00 2026 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1970-01-01 43329 8131.pdf 8131.pdf 1 6DCF18E1D4685C8B9E82F18A1EC1F9FC 274b5d3f426d586e3b96d6df053e6b83f4dcaf7018f2eaad124cca144e659513 6fc2d7ce-c954-11f1-8bc5-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=250692 Medicinska fakulteta 0 0 0