Magnetic resonance imaging findings in giant cell arteritis

Abstract

PurposeGiant cell arteritis (GCA) is a systemic vasculitis that affects medium-to-large-caliber arteries. Early diagnosis and treatment is essential as involvement of the ophthalmic artery or its branches may cause blindness. Radiographic findings may be variable and non-specific leading to delay in diagnosis. We conducted a review of the literature on neuroimaging findings in GCA and present a retrospective case series from tertiary-care ophthalmic referral centers of three patients with significant neuroimaging findings in biopsy-proven GCA.MethodsRetrospective case series of biopsy-proven GCA cases with neuroimaging findings at the Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital between 2010-2015 were included in this study. Literature search was conducted using Google Scholar and Medline search engines between the years 1970 and 2015.ResultsWe report findings of optic nerve enhancement, optic nerve sheath enhancement, and the first description in the English-language ophthalmic literature, to our knowledge, of chiasmal enhancement in biopsy-proven GCA. We describe four main categories of neuroimaging findings that may be seen in GCA from our series and from past cases in the literature.DiscussionIt is essential that clinicians be aware of the possible radiographic findings in GCA. Appropriate and prompt treatment should not be delayed based upon these findings.

A new era for giant cell arteritis

“…Peripheral musculoskeletal manifestations are reported in GCA and PMR, including arthritis, swelling of the distal extremities with pitting oedema (more likely PMR than GCA), tenosynovitis and carpal tunnel syndrome [33], although their presence should alert the clinician to possible alternative diagnoses such as rheumatoid arthritis. Due to the wide ranging phenotype, clinicians require a high index of suspicion for GCA [29] because atypical presentations of GCA may delay diagnosis and lead to further complications [34].…”

“…A contrast-enhanced high-resolution MRI can demonstrate arterial wall thickening with peri-adventitial and mural contrast enhancement [1]. Neuroimaging is not usually required for patients with a typical presentation of GCA, but some patients may have already undergone the investigation previously [34]. Studies have shown MRI to have a sensitivity of 68-89% and a specificity of 73-97% [1].…”

“…However, these findings are not exclusive to GCA, as they can suggest general orbital inflammatory disease, infiltrating or demyelinating disease. On MRI there can also be T2 hypersensitivity, gadolinium enhancement and diffusion weighted imaging restriction, all of which can be seen in GCA-related anterior ischemic optic neuropathy or posterior ischaemic optic neuropathy [34].…”

Visual Loss in Neuro-Ophthalmology

“…Neuroimaging is not usually required in patients with typical presentations of giant cell arteritis (GCA) and when performance is generally normal [18]. However, some patients have already undergone imaging before neuro-ophthalmic evaluation, and these studies may be abnormal.…”

“…MRI findings may hold some diagnostic value in distinguishing between A-AION as in GCA and in nonarteritic AION, in which they are typically normal. Differential diagnosis for these MRI findings can lead to inappropriate testing and delay diagnosis and treatment [18].…”