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AJNR - American Journal of Neuroradiology

Published ahead of print on September 20, 2007
doi: 10.3174/ajnr.A0638

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Diagnostic Value of High-Resolution MR Imaging in Giant Cell Arteritis

T.A. Bley^a, M. Uhl^a, J. Carew^d, M. Markl^a, D. Schmidt^b, H.-H. Peter^c, M. Langer^a and O. Wieben^e

^a Department of Diagnostic Radiology and Medical Physics, University Hospital Freiburg, Freiburg, Germany
^b Department of Ophthalmology, University Hospital Freiburg, Freiburg, Germany
^c Department of Rheumatology and Clinical Immunology, University Hospital Freiburg, Freiburg, Germany
^d Department of Biostatistics and Radiology, Emory University, Atlanta, Ga
^e Department of Medical Physics and Radiology, University of Wisconsin-Madison, Madison, Wis

View larger version (64K): [in this window] [in a new window]   Fig 1. Enlargements of 3T transversal postcontrast fat-suppressed T1-weighted SE image of the superficial temporal arteries of 4 different patients representing typical images of each grade of the 4-point ranking scale. Temporal artery biopsy is negative in cases A and B, and suspected diagnosis of giant cell arteritis is validated by histology in cases C and D. The concomitant veins (arrowheads in A and C) display homogeneous signal intensity increase because of low venous flow. A, Mural thickness <0.5 mm and no mural enhancement; rating "0." Note the intraluminal signal intensity void (light arrow) because of arterial flow. B, Mural thickness <0.5 mm with only slight contrast enhancement (light arrow), probably because of enhancing vasa vasorum; rating "1." C, Mural thickening >0.6 mm and prominent mural enhancement (arrow); rating "2." D, Strong mural thickening >0.7 mm and strong mural enhancement (arrow); rating "3." The arterial lumen is still patent, as signal intensity void consistent with flow can be seen.

View larger version (17K): [in this window] [in a new window]   Fig 2. Feature plot MR score of mural inflammation versus ESR. Patients with an elevated ESR and a high MR score are all diagnosed GCA positive according to the ACR criteria. Patients with a low ESR and a low MR score are mostly diagnosed GCA negative. Please note that 2 of the false-negative MR findings with a very low MR score are imaged after long treatment with corticosteroids. Single points in the plot may represent >1 patient in case of identical values.

View larger version (44K): [in this window] [in a new window]   Fig 3. 3T transversal contrast fat-suppressed T1-weighted SE image acquired with the large FOV that covers the entire cranial circumference. Enlargements of the temporal branch of the superficial temporal arteries (A and B) and of the superficial occipital arteries (C and D) demonstrate the cranial involvement pattern. Mural thickening and inflammatory changes are depicted in the left temporal artery (enlargement B, 0.7-mm mural thickness, rated as "3") and occipital artery (enlargement D, 0.7-mm mural thickness, rated as "3"), whereas the right-sided arteries display no signs of mural inflammation (enlargements A and C, 0.2-mm mural thickness, both rated as "0"). Temporal artery biopsy validates GCA in this patient.