Article Figures & Data
Figures
- 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.
- 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.
- 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.
Tables
- Table 1:
MR imaging vs. clinical critera according to the American College of Rheumatology
Comparison n TP TN FP FN Sens Spec PPV NPV MR vs ACR (all patients) 64 25 32 1 6 80.6 97.0 96.2 84.2 MR vs ACR (<10 days of steroids) 50 24 21 1 4 85.7 95.5 96.0 84.0 MR vs ACR (>10 days) 14 1 11 0 2 33.3 100 100 84.6 Histo vs ACR 32 21 5 0 6 77.8 100 100 45.5 MR vs ACR (patients with histo) 32 22 5 0 5 81.5 100 100 50.0 MR vs histo 32 19 8 3 2 90.5 72.7 86.4 80.0 Wall thickness vs ACR (all patients) 64 22 26 7 9 71.0 78.8 75.9 74.3 Note:—Results of the MR evaluation and temporal artery biopsy in the diagnosis of giant cell arteritis (GCA). The number of subjects (n), true-positive (TP), true-negative (TN), false-positive (FP), and false-negative (FN) cases, as well as the values for sensitivity (Sens), specificity (Spec), positive predictive value (PPV), and negative predictive value (NPV) are reported for all of the patients in the study and various subgroups. Histo indicates histology; ACR, American College of Rheumatology.
GCA Subjects, n CRP, mg/dL ESR Wall, mm Lumen, mm Lumen/wall MR score Positive 31 11.2 ± 7.1 76.1 ± 30.9 0.74 ± 0.32 0.65 ± 0.38 1.23 ± 1.1 2.03 ± 1.05 Negative 33 7.05 ± 7.3 48.8 ± 32.3 0.39 ± 0.18 0.84 ± 0.29 2.63 ± 1.43 0.45 ± 0.56 P value — 0.033 0.0024 0.00014 0.036 0.000676 0.000009 P value ranking — 5 4 2 6 3 1 Note:—Various parameters for the GCA-positive and GCA-negative patient collectives. GCA indicates giant cell arteritis. The C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), wall thickness, lumen diameter, ratio of lumen and wall, and the MR mural inflammation score are presented as mean ± SD. The bottom row shows the ranking of their P values when used as a single predictor for the ACR-based diagnosis, where 1 represents the lowest P value and 6 the highest.
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