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Guggenberger KV, Vogt ML, Song JW, Weng AM, Fröhlich M, Schmalzing M, Venhoff N, Hillenkamp J, Pham M, Meckel S, Bley TA. Intraorbital findings in giant cell arteritis on black blood MRI. Eur Radiol 2023; 33:2529-2535. [PMID: 36394601 PMCID: PMC10017783 DOI: 10.1007/s00330-022-09256-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/25/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Blindness is a feared complication of giant cell arteritis (GCA). However, the spectrum of pathologic orbital imaging findings on magnetic resonance imaging (MRI) in GCA is not well understood. In this study, we assess inflammatory changes of intraorbital structures on black blood MRI (BB-MRI) in patients with GCA compared to age-matched controls. METHODS In this multicenter case-control study, 106 subjects underwent BB-MRI. Fifty-six patients with clinically or histologically diagnosed GCA and 50 age-matched controls without clinical or laboratory evidence of vasculitis were included. All individuals were imaged on a 3-T MR scanner with a post-contrast compressed-sensing (CS) T1-weighted sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) BB-MRI sequence. Imaging results were correlated with available clinical symptoms. RESULTS Eighteen of 56 GCA patients (32%) showed inflammatory changes of at least one of the intraorbital structures. The most common finding was enhancement of at least one of the optic nerve sheaths (N = 13, 72%). Vessel wall enhancement of the ophthalmic artery was unilateral in 8 and bilateral in 3 patients. Enhancement of the optic nerve was observed in one patient. There was no significant correlation between imaging features of inflammation and clinically reported orbital symptoms (p = 0.10). None of the age-matched control patients showed any inflammatory changes of intraorbital structures. CONCLUSIONS BB-MRI revealed inflammatory findings in the orbits in up to 32% of patients with GCA. Optic nerve sheath enhancement was the most common intraorbital inflammatory change on BB-MRI. MRI findings were independent of clinically reported orbital symptoms. KEY POINTS • Up to 32% of GCA patients shows signs of inflammation of intraorbital structures on BB-MRI. • Enhancement of the optic nerve sheath is the most common intraorbital finding in GCA patients on BB-MRI. • Features of inflammation of intraorbital structures are independent of clinically reported symptoms.
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Affiliation(s)
- Konstanze V Guggenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany.
| | - Marius L Vogt
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Jae W Song
- Department of Radiology, Division of Neuroradiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany
| | - Matthias Fröhlich
- Department of Internal Medicine II, Rheumatology and Clinical Immunology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marc Schmalzing
- Department of Internal Medicine II, Rheumatology and Clinical Immunology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Mirko Pham
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stephan Meckel
- Department of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany
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Magnetic resonance imaging findings in giant cell arteritis. Eye (Lond) 2016; 30:758-62. [PMID: 26915748 DOI: 10.1038/eye.2016.19] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/05/2016] [Indexed: 11/09/2022] Open
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.
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