法国巨细胞动脉炎影像学使用建议
法国多学科工作组基于系统文献回顾与专家共识，提出疑似巨细胞动脉炎应尽早影像检查，多普勒超声为首选，FDG-PET、头颅MRI、主动脉MRI和CT可作替代评估颅内外动脉；大血管影像有助于判断预后和随访，疑似视觉型GCA需急诊眼底镜、OCT和视网膜血管造影。
要点
- 疑似GCA应尽早影像检查，多普勒超声为一线首选。
- FDG-PET、头颅MRI、主动脉MRI和CT可替代评估颅内外动脉血管炎。
- 疑似视觉型GCA需急诊眼底镜、OCT和视网膜血管造影。
核心结论
- 工作组推荐对疑似GCA患者尽早行影像检查，多普勒超声为所有疑似患者的一线影像方法。
- FDG-PET、头颅MRI、主动脉MRI和CT扫描可作为评估颅内外动脉的替代方法，提供血管炎影像证据。
- 大血管影像有助于判断预后和制定随访方案；疑似视觉型GCA应急诊行眼底镜、OCT和视网膜血管造影。
研究设计与样本
- 法国23名医师组成的工作组通过系统文献回顾和基于证据与专家意见的迭代过程提出建议，以匿名投票达成共识。
诊断标准与关键数值
- 多普勒超声被推荐为所有疑似GCA患者的一线影像检查。
- FDG-PET、头颅MRI、主动脉MRI和CT扫描可作为评估颅内外动脉血管炎的替代方法。
- 疑似视觉型GCA应急诊行眼底镜、OCT和视网膜血管造影。
- 随访不常规推荐影像，但疑似复发且炎症标志物不可靠时可用影像评估持续血管炎症，并推荐血管活动度评分。
- 影像可用于监测长期结构损伤，尤其在既往发现血管炎症的区域。
临床应用与阅片要点
- 对疑似GCA患者应尽早安排多普勒超声作为一线影像检查。
- 当多普勒超声不可用或需评估颅内外其他动脉时，可选用FDG-PET、头颅MRI、主动脉MRI或CT扫描。
- 对疑似视觉型GCA患者应急诊行眼底镜、OCT和视网膜血管造影以评估视力威胁。
- 随访中疑似复发且炎症标志物不可靠时，可用影像评估血管炎症并采用血管活动度评分。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: We aimed at developing French recommendations for the use of imaging modalities in giant cell arteritis (GCA).
METHODS: A systematic literature review was conducted to identify evidence regarding the use of Doppler ultrasound (DUS), magnetic resonance imaging (MRI), computed tomography (CT) angiography and [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) for diagnosing, monitoring, and predicting the outcome of GCA. The task force, composed of 23 physicians, proposed the recommendations through an iterative process based on evidence and expert opinion, with consensus determined by anonymous voting.
RESULTS: The task force recommends an early imaging test for patients with suspected GCA. The recommendations propose DUS as the first-line imaging test for all patients with suspected GCA. FDG-PET, cranial MRI, aortic MRI and CT-scan can be used as alternative methods to assess the cranial and/or extracranial arteries, providing imaging evidence of vasculitis. Imaging of large vessels is also useful for determining prognosis and follow-up procedures. In patients with suspected visual GCA, ophtalmoscopic fundus examination, optical coherence tomography (OCT) and retinal angiography should be performed in emergency. Although imaging is not routinely recommended for follow-up, it may be used to assess a persistent vascular inflammatory process in patients suspected of relapse, especially when inflammatory biomarkers are unreliable. In this situation, vascular activity scores are recommended for follow-up. Imaging may be used to monitor long-term structural damage, particularly in areas where vascular inflammation has previously been detected.
CONCLUSIONS: The recommendations offer guidance on the use of imaging for diagnosing and evaluating patients with GCA.
引用
- Espitia O, de Boysson H, Heron E, et al. French recommendations for the use of imaging in giant cell arteritis. Joint Bone Spine. 2026. PMID: 42107587. doi:10.1016/j.jbspin.2026.106073
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。