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Published on: February 8, 2019
Influence of corticosteroid treatment on MRI findings in giant cell arteritis
1Department of Diagnostic Radiology and Medical Physics, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. thorsten.bley@uniklinik-freiburg.de
Abstract:
Giant cell arteritis (GCA) remains a diagnostic challenge. With the use of a high-resolution MRI protocol, visualization of the superficial cranial arteries is feasible and mural inflammation can be assessed noninvasively. Until today, it is not known how soon inflammatory signals in diagnostic MR imaging vanish after initiation of treatment. Here, we report sequential MR imaging findings during the initial weeks of corticosteroid treatment in a 79-year-old female patient with histologically proven GCA. Mural inflammatory changes decreased within the first 2 weeks and have almost entirely vanished after 2 1/2 months of continued treatment. Moreover, MR angiography revealed sequential stenoses of the subclavian artery, which improved in variable extent with some residuals despite high dose steroid medication. This report underlines the value of high-resolution MRI in diagnosis and follow-up of GCA and illustrates the potential of MRI to detect and monitor intra- and extra-cranial involvement patterns of GCA in high detail.
Insights
Giant cell arteritis (GCA) diagnosis is challenging. High-resolution MRI shows inflammatory signals decrease within weeks of treatment, aiding GCA monitoring.
Area of Science:
- Vascular Medicine
- Radiology
- Immunology
Background:
- Giant cell arteritis (GCA) diagnosis presents significant challenges.
- High-resolution MRI offers noninvasive assessment of cranial artery inflammation.
- The timeline for resolution of MRI inflammatory signals during GCA treatment is unknown.
Observation:
- Sequential high-resolution MRI was performed on a patient with biopsy-proven GCA during initial corticosteroid therapy.
- Mural inflammatory changes on MRI demonstrated a decrease within two weeks of treatment initiation.
- Subclavian artery stenoses were observed via MR angiography and showed variable improvement.
Findings:
- Inflammatory signals in GCA significantly diminished within the first two weeks of corticosteroid treatment.
- Near-complete resolution of mural inflammation was observed after 2.5 months of sustained treatment.
- MR angiography revealed dynamic changes in arterial stenoses, with some residual disease despite high-dose steroids.
Implications:
- High-resolution MRI is valuable for both diagnosing and monitoring giant cell arteritis.
- MRI can detect and track intracranial and extracranial GCA manifestations in detail.
- This study provides insights into the temporal dynamics of inflammatory changes in GCA during treatment.
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