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Published on: February 8, 2019
Validation of a multimodal algorithm for diagnosing giant cell arteritis with imaging
Augustin Lecler1, Rabih Hage2, Frédérique Charbonneau1
1Department of Radiology, Rothschild Hospital Foundation, 75019 Paris, France.
Insights
Magnetic resonance imaging (MRI) combined with ultrasound or retinal angiography (RA) offers the best diagnostic performance for non-invasive giant cell arteritis (GCA) diagnosis. This imaging strategy is recommended for clinical practice.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Rheumatology
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis affecting large arteries, primarily the aorta and its branches.
- Accurate and timely diagnosis of GCA is crucial to prevent irreversible complications such as vision loss.
- Non-invasive diagnostic methods are preferred to avoid the risks associated with temporal artery biopsy (TAB).
Purpose of the Study:
- To determine the optimal combination of imaging modalities for the non-invasive diagnosis of GCA.
- To evaluate the diagnostic performance of individual and combined imaging techniques.
Main Methods:
- Prospective single-center study involving participants with suspected GCA.
- Utilized high-resolution 3T MRI, temporal and extra-cranial arteries ultrasound, and retinal angiography (RA).
- Compared diagnostic accuracy of each modality alone and in combination, using McNemar test for algorithm construction.
Main Results:
- The combination of MRI followed by ultrasound or RA achieved 100% sensitivity and accuracy.
- Individual modalities showed varying sensitivities and specificities: MRI (100% sensitivity, 86% specificity), ultrasound (88% sensitivity, 84% specificity), and RA (94% sensitivity, 74% specificity).
- Combined imaging strategies demonstrated high sensitivity (95-100%) and specificity (67-100%).
Conclusions:
- An imaging algorithm starting with MRI, followed by ultrasound or RA, provides excellent diagnostic performance for GCA.
- This combined imaging approach is recommended for routine clinical use in diagnosing GCA.
- Non-invasive imaging modalities can effectively diagnose GCA, potentially reducing the need for invasive procedures like TAB.
Purpose:
The purpose of this study was to identify which combination of imaging modalities should be used to obtain the best diagnostic performance for the non-invasive diagnosis of giant cell arteritis (GCA).
Materials And Methods:
This IRB-approved prospective single-center study enrolled participants presenting with a suspected diagnosis of GCA from December 2014 to October 2017. Participants underwent high-resolution 3T magnetic resonance imaging (MRI), temporal and extra-cranial arteries ultrasound and retinal angiography (RA), prior to temporal artery biopsy (TAB). Diagnostic accuracy of each imaging modality alone, then a combination of several imaging modalities, was evaluated. Several algorithms were constructed to test optimal combinations using McNemar test.
Results:
Forty-five participants (24 women, 21 men) with mean age of 75.4 ± 16 (SD) years (range: 59-94 years) were enrolled; of these 43/45 (96%) had ophthalmological symptoms. Diagnosis of GCA was confirmed in 25/45 (56%) patients. Sensitivity and specificity of MRI, ultrasound and RA alone were 100% (25/25; 95% CI: 86-100) and 86% (19/22; 95% CI: 65-97), 88% (22/25; 95% CI: 69-97) and 84% (16/19; 95% CI: 60-97), 94% (15/16; 95% CI: 70-100) and 74% (14/19; 95% CI: 49-91), respectively. Sensitivity, specificity, positive predictive and negative predictive values ranged from 95 to 100% (95% CI: 77-100), 67 to 100% (95% CI: 38-100), 81 to 100% (95% CI: 61-100) and 91 to 100% (95% CI: 59-100) when combining several imaging tests, respectively. The diagnostic algorithm with the overall best diagnostic performance was the one starting with MRI, followed either by ultrasound or RA, yielding 100% sensitivity (22/22; 95% CI: 85-100%) 100% (15/15; 95% CI: 78-100) and 100% accuracy (37/37; 95% CI: 91-100).
Conclusion:
The use of MRI as the first imaging examination followed by either ultrasound or RA reaches high degrees of performance for the diagnosis of GCA and is recommended in daily practice.
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