High-resolution magnetic resonance imaging visualizes intracranial large artery involvement in giant cell arteritis
Konstanze V Guggenberger1,2, Marius L Vogt2, Jae W Song3
1Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany.
Insights
Giant cell arteritis (GCA) can affect intracranial arteries, with 14.5% of patients showing inflammation on advanced MRI. The internal carotid artery was most commonly impacted, though symptoms were mild.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Giant cell arteritis (GCA) is a large vessel vasculitis affecting the aorta and its branches.
- Intracranial involvement in GCA is an area of ongoing research.
- Standard imaging often focuses on extracranial arteries.
Purpose of the Study:
- To assess intracranial artery inflammation in GCA patients using 3D compressed sensing black-blood MRI (3D-CS-BB-MRI).
- To compare intracranial artery inflammation in GCA patients versus age-matched controls.
- To identify the prevalence and location of intracranial vasculitis in GCA.
Main Methods:
- A retrospective, dual-centre case-control study included 105 patients (55 GCA, 50 controls).
- High-resolution 3D-CS-BB-MRI at 3T was performed using a T1-weighted SPACE sequence with 0.55 mm³ isotropic resolution.
- Two blinded neuroradiologists qualitatively scored cerebral arteries for wall thickening and contrast enhancement indicative of inflammation.
Main Results:
- 14.5% of GCA patients (8/55) exhibited intracranial artery inflammation.
- The intradural internal carotid artery (ICA) was the most frequently affected vessel (10.9%).
- No inflammatory changes were observed in age-matched controls; GCA patients with intracranial inflammation reported headaches but no focal neurological deficits.
Conclusions:
- High-resolution 3D-CS-BB-MRI effectively detects intracranial artery inflammation in GCA.
- The intradural ICA is the most commonly affected intracranial artery in GCA.
- While intracranial involvement occurs, it may not correlate with severe neurological deficits.
Objective:
Giant cell arteritis (GCA) is a large vessel vasculitis, typically involving the aorta and its branches with predilection for the scalp arteries. Intracranial involvement is still part of ongoing research. We assessed inflammation of the intracranial arteries on 3D compressed sensing black-blood MRI (3D-CS-BB-MRI) in patients with GCA and age-matched controls.
Methods:
One hundred and five patients with 3D-CS-BB-MRI of the brain were included in this retrospective dual-centre case-control study, 55 with diagnosed GCA and 50 age-matched controls. High-resolution 3D-CS-BB-MRI was performed on a 3 T MR scanner with a post-contrast 3D-compressed-sensing MR pulse sequence, specifically a T1-weighted sampling perfection, application-optimized contrasts using different flip angle evolution (SPACE) pulse sequence with whole-brain coverage and isotropic resolution of 0.55 mm3. Two neuroradiologists blinded to clinical data independently scored the cerebral arteries qualitatively for inflammation; circumferential vessel wall thickening and contrast enhancement were scored positive for vasculitis.
Results:
Eight of 55 GCA patients (14.5%) showed inflammation of at least one intracranial artery. The internal carotid artery (ICA) was affected in 6/55 (10.9%), the vertebral artery in 4/55 (7.3%) and the basilar artery and posterior cerebral artery in 1/55 (1.8%). All patients with inflammatory changes reported headaches and none showed any focal neurological deficit. Besides headache and general weakness, there was no significant correlation between inflammation of the intracranial arteries and clinical symptoms. No age-matched control patient showed inflammatory changes of the intracranial arteries.
Conclusion:
High-resolution 3D-CS-BB-MRI revealed inflammatory changes of intracranial arteries in 14.5% of GCA patients, with the intradural ICA as the most frequently affected vessel.
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