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LETTER TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 11  |  Page : 1655-1656

Comment on: Diagnostic positron emission tomography–computed tomography in clinically elusive giant cell arteritis


1 Birmingham and Midland Eye Centre, Birmingham, UK
2 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication25-Oct-2018

Correspondence Address:
Dr. Sonali Gupta
Birmingham and Midland Eye centre, Dudley Road, Birmingham B18 7QH
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1185_18

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How to cite this article:
Gupta S, Jain S. Comment on: Diagnostic positron emission tomography–computed tomography in clinically elusive giant cell arteritis. Indian J Ophthalmol 2018;66:1655-6

How to cite this URL:
Gupta S, Jain S. Comment on: Diagnostic positron emission tomography–computed tomography in clinically elusive giant cell arteritis. Indian J Ophthalmol [serial online] 2018 [cited 2024 Mar 29];66:1655-6. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2018/66/11/1655/244036



Sir,

Giant cell arteritis (GCA) can be categorized into cranial GCA and large vessel giant cell arteritis (LV-GCA).[1] Cranial GCA frequently presents with headache, jaw claudication, and visual disturbances due to involvement of external carotid artery, whereas LV-GCA usually involves the aorta and its main branches and is often subclinical.[2] The frequency of inflammatory aortic involvement varies from 22% to 85% of GCA cases.[3]

Temporal artery biopsy (TAB) remains the gold standard for diagnosis of cranial GCA with hypoechoic halo on Doppler being similarly useful.[2] The LV-GCA usually spares the temporal arteries, and hence, TAB has a low diagnostic yield for it. Conversely, positron emission tomography–computed tomography (PET-CT) of aorta is a good diagnostic tool for LV-GCA, which presents with constitutional symptoms and has very low risk of ocular involvement.[4]

Mohamed et al. in their article on 'Diagnostic positron emission tomography–computed tomography in clinically elusive giant cell arteritis' describe the utility of PET-CT for diagnosing a patient with headaches and raised erythrocyte sedimentation rate (ESR).[5] We would like to ask the authors why PET-CT of aorta was done as the first investigation for a patient with signs of only cranial GCA. A negative aortic PET-CT cannot rule out cranial GCA. Not just the high cost and limited availability, but the low diagnostic yield of PET-CT in cranial GCA makes it an unlikely choice.

To conclude, PET-CT is of value in LV-GCA presenting with unexplained constitutional symptoms, raised inflammatory markers with negative TAB or Doppler. It is usually not recommended as first line in a patient with headaches or visual disturbances.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Brack A, Martinez-Taboada V, Stanson A, Goronzy JJ, Weyand CM. Disease pattern in cranial and large-vessel giant cell arteritis. Arthritis Rheum 1999;42:311-7.  Back to cited text no. 1
    
2.
Tracy A, Cardy CM, Carruthers D. Large vessel vaculitides. Medicine 2018;46:112-7.  Back to cited text no. 2
    
3.
de Boysson H, Lambert M, Liozon E, Boutemy J, Maigné G, Ollivier Y, et al. Giant-cell arteritis without cranial manifestations: Working diagnosis of a distinct disease pattern. Medicine (Baltimore) 2016;95:e3818.  Back to cited text no. 3
    
4.
Salvarani C, Soriano A, Muratore F, Shoenfeld Y, Blockmans D. Is PET/CT essential in the diagnosis and follow-up of temporal arteritis? Autoimmun Rev 2017;16:1125-30.  Back to cited text no. 4
    
5.
Mohamed R, Djama D, Ayoub T. Diagnostic positron emission tomography-computed tomography in clinically elusive giant cell arteritis. Indian J Ophthalmol 2018;66:693-4.  Back to cited text no. 5
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1 Response to comment on: Diagnostic positron emission tomography-computed tomography in clinically elusive giant cell arteritis
Ryian Mohamed
Indian Journal of Ophthalmology. 2018; 66(11): 1656
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