Magnetic resonance imaging compared to ultrasonography in giant cell arteritis: a cross-sectional study

Abstract

Background There has been a shift in recent years to using ultrasound (US) and magnetic resonance imaging (MRI) as first-line investigations for suspected cranial large vessel vasculitis (LVV) and is a new recommendation by the EULAR 2018 guidelines for imaging in LVV. This cross-sectional study compares the performance of US and MRI and contrast-enhanced magnetic resonance angiography (MRA) for detecting vasculitis in patients with giant cell arteritis (GCA). Methods Patients with new-onset or already diagnosed GCA were recruited. The common temporal arteries and supra-aortic large vessels were evaluated by US and MRI/MRA. Blinded experts read the images and applied a dichotomous score (vasculitis: yes/no) in each vessel. Results Thirty-seven patients with giant cell arteritis (GCA) were recruited. Two patients were excluded. Of the remaining patients, nine had new-onset disease and 26 had established disease. Mean age was 71 years, and median C-reactive protein (CRP) was 7.5 mg/L. The median time between US and MRI was 1 day. Overall, US revealed vasculitic changes more frequently than MRI (p < 0.001). US detected vascular changes in 37% of vessels compared to 21% with MRI. Among patients with chronic disease, US detected vascular changes in 23% of vessels compared to 7% with MRI in (p < 0.001). The same was true for patients with new-onset disease. US detected vasculitic changes in 22% of vessels and MRI detected disease in 6% (p = 0.0004). Compared to contrast-enhanced MRA, US was more sensitive in detecting vasculitic changes in the large arteries, including the axillary, carotid, and subclavian arteries. Conclusion US more frequently detects vasculitic changes in the large arteries compared to contrast-enhanced MRA. When evaluating the cranial vessels, US performs similarly to MRI. This data supports the recommendation that US be considered as a first-line evaluation in patients suspected to have GCA.

Retinal Detachment and Temporal Artery Dissection: An Elusive Case of Giant Cell Arteritis

“…When evaluating the cranial vessels, US performs similarly to MRI. This supports the recommendation that US be considered as a first-line evaluation in patients suspected to have GCA [ 13 ].…”

Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

“…Better results were reported in a recent meta-analysis with a pooled sensitivity of 73% and a specificity of 88% for MRI in comparison to clinical GCA diagnosis and a sensitivity of 93% and a specificity of 81% when temporal artery biopsy was considered as the reference standard [8]. A recent cross-sectional study has compared the performance of MRI to US for detecting vasculitis in 35 patients with new-onset or already diagnosed GCA [41]. No statistical differences for detecting vasculitic changes in temporal arteries were observed between the two imaging techniques, except for the frontal artery where MRI was superior to US.…”

The Emerging Era of Interventional Imaging in Rheumatology: An Overview During the Coronavirus Disease-2019 (COVID-19) Pandemic

“…This has supported the recommendation that US is a leading step in the appraisal of giant cell arteritis (GCA). 21 In the latest PMR criteria, an US scan of the shoulder and pelvis regions was a reliable substitute to clinical assessment. 22 …”