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Radiology. 2014 Dec;273(3):844-52. doi: 10.1148/radiol.14140056. Epub 2014 Aug 6.

Giant cell arteritis: diagnostic accuracy of MR imaging of superficial cranial arteries in initial diagnosis-results from a multicenter trial.

Author information

1
From the Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital-Bern University Hospital, Bern, Switzerland (T.K.); Departments of Radiology-Medical Physics (J.G.), Neurology (M.R.), and Rheumatology and Clinical Immunology (P.V.), University Medical Center Freiburg, Freiburg, Germany; Departments of Diagnostic Radiology (M.B.) and Ophthalmology (D.D.), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Ophthalmology, University Hospital Freiburg, Freiburg, Germany (T.N., S.H.); Institute of Pathology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (K.H.); and Department of Radiology, University of Würzburg, Würzburg, Germany (T.A.B.).

Abstract

PURPOSE:

To assess the diagnostic accuracy of contrast material-enhanced magnetic resonance (MR) imaging of superficial cranial arteries in the initial diagnosis of giant cell arteritis ( GCA giant cell arteritis ).

MATERIALS AND METHODS:

Following institutional review board approval and informed consent, 185 patients suspected of having GCA giant cell arteritis were included in a prospective three-university medical center trial. GCA giant cell arteritis was diagnosed or excluded clinically in all patients (reference standard [final clinical diagnosis]). In 53.0% of patients (98 of 185), temporal artery biopsy ( TAB temporal artery biopsy ) was performed (diagnostic standard [ TAB temporal artery biopsy ]). Two observers independently evaluated contrast-enhanced T1-weighted MR images of superficial cranial arteries by using a four-point scale. Diagnostic accuracy, involvement pattern, and systemic corticosteroid ( sCS systemic corticosteroid ) therapy effects were assessed in comparison with the reference standard (total study cohort) and separately in comparison with the diagnostic standard TAB temporal artery biopsy ( TAB temporal artery biopsy subcohort). Statistical analysis included diagnostic accuracy parameters, interobserver agreement, and receiver operating characteristic analysis.

RESULTS:

Sensitivity of MR imaging was 78.4% and specificity was 90.4% for the total study cohort, and sensitivity was 88.7% and specificity was 75.0% for the TAB temporal artery biopsy subcohort (first observer). Diagnostic accuracy was comparable for both observers, with good interobserver agreement ( TAB temporal artery biopsy subcohort, κ = 0.718; total study cohort, κ = 0.676). MR imaging scores were significantly higher in patients with GCA giant cell arteritis -positive results than in patients with GCA giant cell arteritis -negative results ( TAB temporal artery biopsy subcohort and total study cohort, P < .001). Diagnostic accuracy of MR imaging was high in patients without and with sCS systemic corticosteroid therapy for 5 days or fewer (area under the curve, ≥0.9) and was decreased in patients receiving sCS systemic corticosteroid therapy for 6-14 days. In 56.5% of patients with TAB temporal artery biopsy -positive results (35 of 62), MR imaging displayed symmetrical and simultaneous inflammation of arterial segments.

CONCLUSION:

MR imaging of superficial cranial arteries is accurate in the initial diagnosis of GCA giant cell arteritis . Sensitivity probably decreases after more than 5 days of sCS systemic corticosteroid therapy; thus, imaging should not be delayed. Clinical trial registration no. DRKS00000594 .

PMID:
25102371
DOI:
10.1148/radiol.14140056
[Indexed for MEDLINE]

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