Objectives MRI is well established for diagnosing GCA. Its role in monitoring disease activity has yet to be determined. We investigated vascular and musculoskeletal inflammation using MRI in the patients of the GUSTO trial to assess the utility of MRI in monitoring disease activity. Methods Eighteen patients with newly diagnosed GCA received 500 mg methylprednisolone intravenously for 3 consecutive days followed by tocilizumab monotherapy from day 3 until week 52. Cranial, thoracic and abdominal MRI exams were performed at baseline (active, new-onset disease), and at weeks 24, 52 (remission on-treatment), and 104 (remission off-treatment). MRI findings typical for PMR as well as extent and severity of vasculitic disease were rated. Results In total, 673 vascular segments and 943 musculoskeletal regions in 55 thoracic/abdominal MRI and 490 vascular segments in 49 cranial MRI scans of 18 patients were analysed. Vasculitic vessels were still detectable in one in four cranial segments at week 24. At weeks 52 and 104, no cranial vascular segment showed a vasculitic manifestation. Large vessels, except for the ascending aorta, and PMR displayed little or no decrease in inflammatory findings over time. Conclusion Vasculitic manifestations in the cranial vessels normalised after 52 weeks of treatment, whereas large vessel and PMR findings persisted despite lasting full remission. The dynamics of cranial vessel signals suggest that MRI of these arteries might qualify as a potential diagnostic tool for monitoring disease activity and for detecting relapse after 52 weeks of treatment.

中文翻译：

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磁共振成像监测超短程糖皮质激素和托珠单抗治疗巨细胞动脉炎的疾病活动度


目标 MRI 已广泛用于诊断 GCA。其在监测疾病活动方面的作用尚未确定。我们使用 MRI 对 GUSTO 试验患者的血管和肌肉骨骼炎症进行了研究，以评估 MRI 在监测疾病活动方面的效用。方法 18 名新诊断 GCA 患者连续 3 天静脉注射 500 mg 甲基泼尼松龙，然后从第 3 天至第 52 周接受托珠单抗单药治疗。在基线（活动性、新发疾病）和周时进行头颅、胸部和腹部 MRI 检查24、52（治疗缓解）和 104（治疗结束缓解）。对 PMR 的典型 MRI 结果以及血管炎疾病的范围和严重程度进行了评估。结果 总共分析了 18 名患者的 55 幅胸腹部 MRI 中的 673 个血管段和 943 个肌肉骨骼区域以及 49 幅颅脑 MRI 扫描中的 490 个血管段。第 24 周时，四分之一的颅段仍可检测到血管炎血管。第 52 周和第 104 周时，没有颅段血管显示出血管炎表现。大血管（升主动脉除外）随着时间的推移，PMR 的炎症表现几乎没有减少或没有减少。结论 治疗 52 周后，颅血管血管炎表现正常化，而大血管和 PMR 表现尽管持续完全缓解，但仍持续存在。颅血管信号的动态表明，这些动脉的 MRI 可能有资格作为监测疾病活动性和检测 52 周治疗后复发的潜在诊断工具。