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Advanced Imaging Techniques Use in Giant Cell Arteritis Diagnosis: The Experience at Walter Reed National Military
Nicholas Lehman1, Alexander Choi2, Kenneth Dalton1
1Walter Reed National Military Medical Center, Bethesda, Maryland.
Background:
If not diagnosed in a timely manner, giant cell arteritis (GCA) can lead to significant morbidity. The 1990 American College of Rheumatology criteria for GCA do not include screening technologies, though proposed criteria do.
Methods:
This study evaluated current clinical practices in diagnosing GCA and the use of screening technologies such as ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET). A retrospective chart review was conducted of patients who underwent diagnostic testing for GCA from 2016 through 2022 at Walter Reed National Military Medical Center.
Results:
Seventy-eight charts were reviewed; 42 patients (54%) had a GCA diagnosis and 36 patients (46%) were GCA negative. Temporal artery biopsy was positive for 19 (45%) patients. Most patients did not undergo bilateral temporal artery biopsies despite recommendations. Among those diagnosed with GCA, 29 (69%) underwent biopsy, and 25 (60%) received diagnostic imaging.
Conclusions:
Evidence supports the use of additional screening tools beyond clinical and laboratory data to improve the diagnostic yield of temporal artery biopsy. Initial screening with ultrasound is a cost-effective and widely available modality that may reduce the risk of false-negative biopsy results. Other tests include vascular MRI/CT and PET. The target goal is to increase the diagnostic yield of temporal artery biopsies to ≥ 70%.
