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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
3T MRI reveals extra- and intracranial involvement in giant cell arteritis
S Siemonsen1, C Brekenfeld2, B Holst2
1From the Department of Diagnostic and Interventional Neuroradiology (S.S., T.A.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany s.siemonsen@uke.uni-hamburg.de.
Background And Purpose:
The frequency and amount of intracranial, intradural inflammatory vessel wall enhancement in giant cell arteritis remain unclear. The purpose of this work was to prospectively assess the intracranial extent of vasculitic changes in patients with giant cell arteritis using a dedicated MR imaging protocol optimized for assessment of mural changes of intracranial arteries.
Materials And Methods:
Twenty-eight patients with suspected giant cell arteritis underwent 3T MR imaging. Imaging included a fat-saturated T1WI pre- and postcontrast application optimized for assessment of intradural vessel wall enhancement and high-resolution fat-saturated T1WI to evaluate superficial extracranial vessels. Temporal artery biopsies were available in 11 cases. Vessel wall enhancement of intradural and extracranial vessels was evaluated by 2 observers independently.
Results:
Twenty patients had giant cell arteritis; 9 cases were biopsy-proved. Clear vessel wall enhancement of superficial extracranial and intradural internal carotid arteries was detected in 16 and 10 patients, respectively. Slight vessel wall enhancement of the vertebral arteries was seen. Of 9 patients with giant cell arteritis with vessel occlusion or stenosis, 2 presented with cerebral ischemic infarcts. Vessel occlusion or stenosis site coincided with the location of vessel wall enhancement of the vertebral arteries in 4 patients and of the intradural ICA in 1 patient.
Conclusions:
Vessel wall enhancement of intradural arteries, mainly the ICA, can be regularly found in patients with giant cell arteritis. Mural inflammatory changes of the intradural ICA detected on MR imaging may identify a subgroup of patients with giant cell arteritis and should be further evaluated in clinical studies.
Insights
Giant cell arteritis commonly shows inflammation in intracranial arteries, particularly the internal carotid artery (ICA). MR imaging can detect this mural inflammation, aiding in identifying affected patients.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis affecting large and medium-sized arteries.
- The extent of intracranial and intradural arterial involvement in GCA is not well-defined.
Purpose of the Study:
- To prospectively evaluate the intracranial and intradural inflammatory vessel wall enhancement in patients with suspected GCA.
- To assess mural changes in intracranial arteries using a specialized MR imaging protocol.
Main Methods:
- 28 patients with suspected GCA underwent 3T MR imaging.
- Imaging included fat-saturated T1WI pre- and postcontrast for intradural vessel wall enhancement and high-resolution imaging for extracranial vessels.
- Vessel wall enhancement was independently assessed by two observers; temporal artery biopsies were available for 11 patients.
Main Results:
- GCA was confirmed in 20 patients (9 biopsy-proven).
- Intradural internal carotid artery (ICA) enhancement was detected in 10 patients; extracranial vessel enhancement in 16.
- Slight vertebral artery enhancement was observed; vessel occlusion/stenosis correlated with enhancement sites in some cases.
Conclusions:
- Intradural arterial wall enhancement, primarily in the ICA, is a common finding in GCA.
- MR imaging detection of mural inflammation in the intradural ICA may identify a specific patient subgroup.
- Further clinical studies are warranted to evaluate the significance of these findings.
