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DWI scrolling artery sign for the diagnosis of giant cell arteritis: a pattern recognition approach
Luca Seitz1, Susana Bucher2, Lukas Bütikofer3
1Department of Rheumatology and Immunology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland luca.seitz@insel.ch.
Insights
A new pattern recognition approach using diffusion-weighted imaging (DWI) called the DWI-Scrolling-Artery-Sign (DSAS) shows high accuracy for diagnosing giant cell arteritis (GCA). This quick MRI technique is reliable and ready for clinical use.
Area of Science:
- Radiology
- Neuroimaging
- Vascular Imaging
Background:
- Giant cell arteritis (GCA) is a vasculitis affecting large arteries, often involving the head and neck.
- Accurate and timely diagnosis of GCA is crucial to prevent complications like vision loss.
- Current diagnostic methods may have limitations, necessitating novel imaging approaches.
Purpose of the Study:
- To evaluate the diagnostic accuracy of a pattern recognition method on head MRI using diffusion-weighted imaging (DWI) for suspected GCA.
- To assess the reliability and speed of the DWI-Scrolling-Artery-Sign (DSAS) for GCA diagnosis.
Main Methods:
- Retrospective analysis of 156 patients with suspected GCA undergoing head MRI.
- Identification and rating of the DWI-Scrolling-Artery-Sign (DSAS) by experts and a novice.
- Comparison of DSAS findings with T1-weighted black-blood sequences and clinical diagnosis after follow-up.
Main Results:
- The DSAS demonstrated high sensitivity and specificity in diagnosing GCA, with expert performance at 73.6% sensitivity and 94.2% specificity.
- Excellent inter-reader agreement was observed for DSAS assessment among experts and between experts and a novice.
- DSAS assessment was rapid, taking less than one minute per scan.
Conclusions:
- The DWI-Scrolling-Artery-Sign (DSAS) is a reliable imaging biomarker for GCA diagnosis.
- This pattern recognition approach using DWI offers good diagnostic accuracy and can be implemented quickly in clinical practice.
Objectives:
To investigate the diagnostic accuracy of a pattern recognition approach for the evaluation of MRI scans of the head with diffusion-weighted imaging (DWI) in suspected giant cell arteritis (GCA).
Methods:
Retrospectively, 156 patients with suspected GCA were included. The 'DWI-Scrolling-Artery-Sign' (DSAS) was defined as hyperintense DWI signals in the cranial subcutaneous tissue that gives the impression of a blood vessel when scrolling through a stack of images. The DSAS was rated by experts and a novice in four regions (frontotemporal and occipital, bilaterally). The temporal, occipital and posterior auricular arteries were assessed in the T1-weighted black-blood sequence (T1-BB). The diagnostic reference was the clinical diagnosis after ≥6 months of follow-up.
Results:
The population consisted of 87 patients with and 69 without GCA; median age was 71 years and 59% were women. The DSAS showed a sensitivity of 73.6% and specificity of 94.2% (experts) and 59.8% and 95.7% (novice), respectively. Agreement between DSAS and T1-BB was 80% for the region level (499/624; kappa(κ)=0.59) and 86.5% for the patient level (135/156; κ=0.73). Inter-reader agreement was 95% (19/20; κ=0.90) for DSAS on the patient level and 91.3% (73/80; κ=0.81) on the region level for experts. For expert versus novice, inter-reader agreement for DSAS was 87.8% on the patient level (137/156; κ=0.75) and 91.2% on the region level (569/624; κ=0.77).
Conclusions:
The DSAS can be assessed in less than 1 min and has a good diagnostic accuracy and reliability for the diagnosis of GCA. The DSAS can be used immediately in clinical practice.
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