title: Sonographic and clinical pattern of extracranial and cranial giant cell arteritis.
abstract: OBJECTIVE
  The aim of our study was to describe the sonographic pattern and clinical manifestations of extracranial (i.e. carotid and proximal arm arteries) and cranial arterial involvement in patients with giant cell arteritis (GCA).
  
  
  METHODS
  One hundred and ten consecutive patients with an established diagnosis of GCA between January 2002 and June 2010 were identified retrospectively from a database. All patients underwent colour duplex sonography (CDS) of the superficial temporal, carotid, and proximal arm arteries at the time of diagnosis. Circumferential, homogeneous, hypoechogenic wall thickening was regarded as a typical sign for GCA. Sonographic and clinical characteristics of patients with and without extracranial vessel involvement were compared.
  
  
  RESULTS
  Extracranial GCA was observed in 59 of 110 subjects (53.6%). The axillary artery (48.2%) was most frequently affected and bilateral vessel involvement was present in almost all patients (94.8%). Compared to patients with cranial GCA, patients with extracranial GCA were significantly younger, frequently did not meet the American College of Rheumatology (ACR) criteria for classification of cranial GCA, exhibited a lower rate of permanent visual impairment, and were diagnosed later after onset of clinical symptoms (all p < 0.01). With increasing age, a continuous shift from GCA with extracranial arterial involvement to cranial GCA was observed.
  
  
  CONCLUSIONS
  Using CDS, extracranial GCA is a common finding, most frequently observed in the axillary arteries. The clinical pattern of GCA with extracranial arterial involvement differs from that of cranial GCA.
authors.affiliation: Divisions of Vascular Medicine Medical Policlinic, Campus City Centre, University Hospital Munich, Munich, Germany. michael.czihal@med.uni-muenchen.de
authors.forename: M
authors.initials: M
authors.lastname: Czihal
authors.forename: S
authors.initials: S
authors.lastname: Zanker
authors.forename: A
authors.initials: A
authors.lastname: Rademacher
authors.forename: F
authors.initials: F
authors.lastname: Tatò
authors.forename: P J
authors.initials: PJ
authors.lastname: Kuhlencordt
authors.forename: H
authors.initials: H
authors.lastname: Schulze-Koops
authors.forename: U
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D000367:Age Factors; D000368:Aged; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000473:pathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D013700:Giant Cell Arteritis / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D018615:Ultrasonography, Doppler, Color