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Published on: February 8, 2019
Magnetic resonance angiography in extracranial giant cell arteritis
Marcel Koenigkam-Santos1, Puneet Sharma, Bobby Kalb
1Department of Radiology, School of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil. marcelk46@yahoo.com.br
Insights
Magnetic resonance imaging (MRI) effectively detects extracranial giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) involvement, even in cases lacking typical symptoms or biopsy confirmation. This imaging aids in diagnosing occult large artery vasculitis.
Area of Science:
- Vascular Medicine
- Rheumatology
- Radiology
Background:
- Noninvasive diagnosis of giant cell arteritis (GCA) is challenging, especially for extracranial arterial disease.
- Accurate imaging is crucial for timely diagnosis and management.
Purpose of the Study:
- To retrospectively review extracranial involvement in GCA/PMR patients using MRI.
- To evaluate 3D contrast-enhanced MR angiography of the aortic arch and its branches.
Main Methods:
- Reviewed clinical data and MRI scans of 28 GCA/PMR patients.
- Radiologists assessed images, comparing them with 20 controls.
- Interobserver agreement for stenosis detection was calculated using the k coefficient.
Main Results:
- Vascular alterations consistent with extracranial GCA were identified in 67% of patients (19/28).
- High agreement was found for stenosis detection (k=0.73) and classification (k=1.00).
- Bilateral axillary stenosis/obstruction was the most common finding (28%).
Conclusions:
- MRI accurately depicts aortic arch and branch involvement in extracranial GCA.
- Occult large artery vasculitis should be considered in GCA/PMR patients with atypical presentations.
- MRI aids in diagnosing GCA/PMR even without biopsy or clear clinical signs.
Background:
Noninvasive diagnosis of giant cell arteritis (GCA) remains challenging, particularly with regard to evaluation of extracranial arterial disease.
Objectives:
The objective of the study was to retrospectively review extracranial involvement in patients with GCA and/or polymyalgia rheumatica (PMR), evaluated with magnetic resonance imaging (MRI), especially 3-dimensional contrast-enhanced magnetic resonance angiography images of the aortic arch and its branches.
Methods:
Clinical information, biopsy status, and MRI examinations of 28 patients with GCA/PMR were reviewed. Patient images were mixed randomly with 20 normal control images and were independently reviewed by 2 radiologists. Interobserver agreement for detection of arterial stenosis was determined by the k coefficient.
Results:
Both readers described vascular alterations in keeping with extracranial GCA in 19 of 28 patients (67%) with good interobserver agreement (k = 0.73) and with even higher agreement on diagnosing nonocclusive versus occlusive disease (k = 1.00). The most common lesions were bilateral axillary stenosis or obstructions, observed by both readers in 8 patients (28%). Among the 19 patients with magnetic resonance angiography lesions in the subclavian/axillary arteries, 12 (75%) had biopsy-proven GCA, but only 5 (41%) of these patients had clinical features of large artery disease.
Conclusions:
In our series review, MRI could provide accurate information on involvement of the aortic arch and its branches in extracranial GCA, depicting different degrees of stenosis. Our analysis also illustrates that occult large artery vasculitis should be considered in patients without biopsy-proven GCA, patients with classic GCA but without clinical signs of large artery disease, and in patients initially diagnosed as having PMR.
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