Article Figures & Data
Figures
- FIG 1.
H&E (A) and Verhoeff-van Giesson (VVG) (B) stain photomicrographs from a temporal artery biopsy in a positive GCA case reveal severe arteritis with inflammatory lymphocytic cells throughout the vessel wall (A and B). There is loss of the internal elastic membrane (B, arrow) with marked intimal fibroplasia (asterisk), resulting in complete obliteration of lumen. Inserts with magnified views show multinucleated giant cells (arrowheads) interspersed between lymphocytes.
- FIG 2.
Halo sign and compressibility test in a patient with biopsy-proved GCA. Ultrasound images (A and B) show a dark hypoechoic halo around the STA lumen (arrows), representing the vessel wall inflammation with partial loss of normal compressibility and decrease in flow.
- FIG 3.
Sagittal postcontrast T1-SPACE image shows circumferential wall enhancement along the right superficial temporal artery (STA, arrow, A). Oblique MPR images perpendicular to the involved vessel (in A) show corresponding circumferential enhancement (arrowhead, B). The left STA (arrowhead, C) is normal.
- FIG 4.
Axial DWI in a treatment-naïve patient with GCA showing scattered foci of increased diffusion signal along bilateral scalp vessels (arrowheads). Inset in bottom left shows magnified diffusion-weighted signal changes along the right frontal STA branch.
- FIG 5.
Long-standing GCA in a 66-year-old woman with pseudoaneurysm of the superficial temporal artery. Frontal (A) and lateral (B) projections on catheter angiogram (External carotid artery injection) reveal multifocal areas of narrowing involving the frontal and parietal branches of STA (A and B, arrows). A small pseudoaneurysm is noted along the frontal branch of STA (A and B, arrowheads). Temporal artery biopsy with H&E (C) and Verhoeff-van Giesson (VVG) (D) stains reveals marked atrophy of the arterial wall (C and D, arrows), suggesting healing with pseudoaneurysm (C and D, arrowheads).
- FIG 6.
Axial postcontrast images reveal flow artifacts in the right occipital vein (arrows), which should not be misinterpreted as mural inflammatory changes. There is circumferential enhancement along the right superficial occipital artery (arrowheads).
- FIG 7.
Sagittal CTA-MPR image (A) reveals blurring of vessel margins and subtle fat stranding along the frontal branch of the right STA. Volume-rendered image (B) shows scattered areas of vessel irregularity and stenosis along the STA branches (arrows).
- FIG 8.
Axial CTA image (A) in a patient with newly diagnosed GCA shows reduced contrast opacification along the left STA (arrow) and a normal-appearing right STA (arrowhead). Fused PET-CT image (B) from the same patient at a slightly cranial level shows prominent radiotracer uptake on the left (circled).
- FIG 9.
Axial T1-SPACE postcontrast image through the orbits in a patient with newly diagnosed GCA shows bilateral retrobulbar intraconal enhancement near the apex with involvement of bilateral ophthalmic arteries (arrows).
- FIG 10.
Axial T1-SPACE postcontrast image (same patient as Fig 9) shows asymmetrically increased enhancement along the right temporalis muscle (arrows) and along the deep temporal artery (arrowhead).
Tables
Updated classification criteria for GCA diagnosis
Classification Criteria for Giant Cell Arteritisa 2022 American College of Rheumatology & European Alliance of Associations for Rheumatology Absolute requirement • Age ≥50 years at time of diagnosis Additional clinical criteria • Morning stiffness in shoulder/neck area +2 • Sudden visual loss +3 • Jaw or tongue claudication +2 • New temporal headache +2 • Scalp tenderness +2 • Abnormal examination of temporal artery +2 Laboratory, imaging & biopsy criteria • Maximum ESR ≥50 mm/h or maximum CRP ≥10 mg/L +3 • Positive temporal artery biopsy or halo sign on ultrasound +5 • Bilateral axillary involvement +2 • FDG-PET activity throughout aorta +2 Sum the scores for 10 items, if present. A score of ≥6 points is needed for diagnosis of giant cell arteritis aConsideration while applying the criteria • Classification criteria should be applied when a diagnosis of medium-vessel or large-vessel vasculitis has been made • Alternate diagnosis mimicking vasculitis should be excluded before applying the criteria ↵a Adapted from Ponte C, Grayson PC, Robson JC; DCVAS Study Group, et al. 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Arthritis Rheumatol 2022;74:1881–89.
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