1
|
El Haddad J, Charbonneau F, Guillaume J, Clavel G, Chazal T, Poillon G, Tran A, Niro A, Sore R, Litman-Roventa L, Mahe K, Chhour S, Savatovsky J, Lecler A. Reproducibility and accuracy of vessel wall MRI in diagnosing giant cell arteritis: a study with readers of varying expertise. Eur Radiol 2024:10.1007/s00330-023-10567-6. [PMID: 38206404 DOI: 10.1007/s00330-023-10567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 11/16/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To evaluate the reproducibility of vessel wall magnetic resonance imaging (VW-MRI) in diagnosing giant cell arteritis (GCA) among groups of radiologists with varying levels of expertise. METHODS This institutional review board-approved retrospective single-center study recruited patients with suspected GCA between December 2014 and September 2021. Patients underwent 3 -T VW-MRI before temporal artery biopsy. Ten radiologists with varying levels of expertise, blinded to all data, evaluated several intracranial and extracranial arteries to assess GCA diagnosis. Interobserver reproducibility and diagnostic performance were evaluated. RESULTS Fifty patients (27 women and 23 men) with a mean age of 75.9 ± 9 years were included. Thirty-one of 50 (62%) had a final diagnosis of GCA.VW-MRI had an almost perfect reproducibility among expert readers (kappa = 0.93; 95% CI 0.77-1) and substantial reproducibility among all readers, junior and non-expert senior readers (kappa = 0.7; 95% CI 0.66-0.73; kappa = 0.67 95% CI 0.59-0.74; kappa = 0.65; 95% CI 0.43-0.88 respectively) when diagnosing GCA. Substantial interobserver agreement was observed for the frontal branch of superficial temporal artery. Moderate interobserver agreement was observed for the superficial temporal artery and its parietal branch, as well as ophthalmic arteries in all groups of readers. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy varied depending on the group of readers. CONCLUSION VW-MRI is a reproducible and accurate imaging modality for detecting GCA, even among less-experienced readers. This study advocates for the use of VW-MRI when diagnosing GCA even in less-experienced centers. CLINICAL RELEVANCE STATEMENT VW-MRI is a reproducible and accurate imaging modality for detecting GCA, even among less-experienced readers, and it could be used as a first-line diagnostic tool for GCA in centers with limited expertise in GCA diagnosis. KEY POINTS • Vessel wall magnetic resonance imaging (VW-MRI) is a reproducible and accurate imaging modality for detecting giant cell arteritis (GCA) in both extracranial and intracranial arteries. • The reproducibility of vessel wall magnetic resonance imaging for giant cell arteritis diagnosis was high among expert readers and moderate among less-experienced readers. • The use of vessel wall magnetic resonance imaging for giant cell arteritis diagnosis can be recommended even in centers with less-experienced readers.
Collapse
Affiliation(s)
- Jérôme El Haddad
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France.
| | | | - Jessica Guillaume
- Department of Clinical Research, A. Rothschild Foundation Hospital, Paris, France
| | - Gaëlle Clavel
- Department of Internal Medicine, A. Rothschild Foundation Hospital, Paris, France
| | - Thibaud Chazal
- Department of Internal Medicine, A. Rothschild Foundation Hospital, Paris, France
| | - Guillaume Poillon
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Alexia Tran
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Alexandre Niro
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Rémi Sore
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Luca Litman-Roventa
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Kévin Mahe
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Samantha Chhour
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Julien Savatovsky
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Augustin Lecler
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France.
| |
Collapse
|
2
|
Owen CE, Yates M, Liew DFL, Poon AMT, Keen HI, Hill CL, Mackie SL. Imaging of giant cell arteritis - recent advances. Best Pract Res Clin Rheumatol 2023; 37:101827. [PMID: 37277245 DOI: 10.1016/j.berh.2023.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 06/07/2023]
Abstract
Imaging is increasingly being used to guide clinical decision-making in patients with giant cell arteritis (GCA). While ultrasound has been rapidly adopted in fast-track clinics worldwide as an alternative to temporal artery biopsy for the diagnosis of cranial disease, whole-body PET/CT is emerging as a potential gold standard test for establishing large vessel involvement. However, many unanswered questions remain about the optimal approach to imaging in GCA. For example, it is uncertain how best to monitor disease activity, given there is frequent discordance between imaging findings and conventional disease activity measures, and imaging changes typically fail to resolve completely with treatment. This chapter addresses the current body of evidence for the use of imaging modalities in GCA across the spectrum of diagnosis, monitoring disease activity, and long-term surveillance for structural changes of aortic dilatation and aneurysm formation and provides suggestions for future research directions.
Collapse
Affiliation(s)
- Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
| | - Max Yates
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Aurora M T Poon
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
| | - Helen I Keen
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine L Hill
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom; NIHR-Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, United Kingdom
| |
Collapse
|
3
|
Vijayaraghavan N, Martin J, Jayawickrama W, Otome O. Atypical giant cell arteritis presentations diagnosed with FDG-18 whole body PET imaging. BMJ Case Rep 2023; 16:e251406. [PMID: 36631167 PMCID: PMC9835878 DOI: 10.1136/bcr-2022-251406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Two male patients aged above 70 years were investigated for chronic non-specific symptoms and evidence of significant systemic inflammation, but without classic 'cranial symptoms' of giant cell arteritis (GCA). Each patient had multiple non-diagnostic investigations, but finally extensive large-vessel vasculitis was revealed by whole body positron emission tomography/CT imaging. Both cases were confirmed to have GCA on temporal artery biopsy and responded well to initial high-dose prednisolone therapy. The patients successfully completed 12 months of steroid-sparing therapy with tocilizumab and achieved remission of their condition.
Collapse
Affiliation(s)
- Nimal Vijayaraghavan
- Department of General Medicine, Rockingham General Hospital, Cooloongup, Western Australia, Australia
| | - Jaye Martin
- Department of General Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Waranga Jayawickrama
- Department of General Medicine, Rockingham General Hospital, Cooloongup, Western Australia, Australia
| | - Ohide Otome
- Department of General Medicine, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
4
|
Monti S, Schäfer VS, Muratore F, Salvarani C, Montecucco C, Luqmani R. Updates on the diagnosis and monitoring of giant cell arteritis. Front Med (Lausanne) 2023; 10:1125141. [PMID: 36910481 PMCID: PMC9995793 DOI: 10.3389/fmed.2023.1125141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
This mini-review offers a critical appraisal of the currently employed imaging or histopathological tools to diagnose and monitor giant cell arteritis (GCA). An overview of the most updated evidence and current application of color duplex ultrasonography (US), temporal artery biopsy (TAB), 18-fluorodeoxyglucose [18F] FDG-PET/CT, magnetic resonance imaging, and computed tomography angiography is provided. The main limitations of each tool, and the most relevant research developments are discussed. The review highlights the complementary value of the available modalities to ensure a correct diagnosis of GCA, and to provide valuable prognostic information. Novel evidence is accumulating to support the role of imaging, and particularly US, as a monitoring tool for the disease, opening new perspectives for the future management of large vessel vasculitis.
Collapse
Affiliation(s)
- Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy.,Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentin Sebastian Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, Bonn, Germany
| | - Francesco Muratore
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy.,Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raashid Luqmani
- Rheumatology Department, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
5
|
Predictive Factors of Giant Cell Arteritis in Polymyalgia Rheumatica Patients. J Clin Med 2022; 11:jcm11247412. [PMID: 36556036 PMCID: PMC9785629 DOI: 10.3390/jcm11247412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Polymyalgia rheumatica (PMR) is an inflammatory rheumatism of the shoulder and pelvic girdles. In 16 to 21% of cases, PMR is associated with giant cell arteritis (GCA) that can lead to severe vascular complications. Ruling out GCA in patients with PMR is currently a critical challenge for clinicians. Two GCA phenotypes can be distinguished: cranial GCA (C-GCA) and large vessel GCA (LV-GCA). C-GCA is usually suspected when cranial manifestations (temporal headaches, jaw claudication, scalp tenderness, or visual disturbances) occur. Isolated LV-GCA is more difficult to diagnose, due to the lack of specificity of clinical features which can be limited to constitutional symptoms and/or unexplained fever. Furthermore, many studies have demonstrated the existence-in varying proportions-of subclinical GCA in patients with apparently isolated PMR features. In PMR patients, the occurrence of clinical features of C-GCA (new onset temporal headaches, jaw claudication, or abnormality of temporal arteries) are highly predictive of C-GCA. Additionally, glucocorticoids' resistance occurring during follow-up of PMR patients, the occurrence of constitutional symptoms, or acute phase reactants elevation are suggestive of associated GCA. Research into the predictive biomarkers of GCA in PMR patients is critical for selecting PMR patients for whom imaging and/or temporal artery biopsy is necessary. To date, Angiopoietin-2 and MMP-3 are powerful for predicting GCA in PMR patients, but these results need to be confirmed in further cohorts. In this review, we discuss the diagnostic challenges of subclinical GCA in PMR patients and will review the predictive factors of GCA in PMR patients.
Collapse
|