Giant cell arteritis
Suspicion of giant cell arteritis and recent new headaches. No anti-inflammatory treatment. Normal ophthalmological exam.
High resolution MRI of superficial temporal artery and regular thoracic angiography
Loading Stack -
0 images remaining
Axial T1C+ FS scan of the extracranial arteries demonstrates mural thickening and bilateral mural contrast enhancement of the superficial temporal arteries.
Mild chronic frontal/ethmoidal sinusitis is shown.
Normal presentation of the thoracic vessels.
Giant cell arteritis (GCA) with typical involvement of the superficial temporal artery is the commonest vasculitis in a Caucasian population. Biopsy is the de facto "gold standard" for diagnosis, however assessment with high resolution contrast enhanced and fat saturated T1- MRI is possible and can also be used for monitoring during/following anti-inflammatory/immunosuppressive therapy. Unlike a biopsy, of course, MRI allows simultaneous assessment of all superficial artery segments.
A symmetrical and simultaneous vascular inflammation of superficial cranial arteries is the typical pattern. MRI imaging signs may vanish after 5-7 days of systemic anti-inflammatory therapy with steroids.
For ranking of mural contrast enhancement, the following four-point scale proposed by Bley et al. can be used:
-, no enhancement; +, slight mural enhancement; ++, prominent mural enhancement; and +++, strong mural enhancement, including perivascular tissue.
NB: for the thickness of the superficial temporal artery wall, the cut-off between unaffected and inflamed arteries is 0.6-0.7 mm.
- 1. Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev. 2007;15 (2): 55-61. doi:10.1097/01.crd.0000218853.05856.b6 - Pubmed citation
- 2. Atalay MK, Bluemke DA. Magnetic resonance imaging of large vessel vasculitis. Curr Opin Rheumatol. 2001;13 (1): 41-7. Pubmed citation
- 3. Klink T, Geiger J, Both M et-al. Giant cell arteritis: diagnostic accuracy of MR imaging of superficial cranial arteries in initial diagnosis-results from a multicenter trial. Radiology. 2014;273 (3): 844-52. doi:10.1148/radiol.14140056 - Pubmed citation
- 4. Bley TA, Wieben O, Uhl M et-al. High-resolution MRI in giant cell arteritis: imaging of the wall of the superficial temporal artery. AJR Am J Roentgenol. 2005;184 (1): 283-7. doi:10.2214/ajr.184.1.01840283 - Pubmed citation
- 5. Schmidt WA, Kraft HE, Vorpahl K et-al. Color duplex ultrasonography in the diagnosis of temporal arteritis. N. Engl. J. Med. 1997;337 (19): 1336-42. doi:10.1056/NEJM199711063371902 - Pubmed citation