Giant Cell Arteritis: Diagnostic Accuracy of MR Imaging of Superficial Cranial Arteries in Initial Diagnosis—Results from a Multicenter Trial

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This prospective, multicenter trial demonstrates that contrast-enhanced MR imaging is accurate and reproducible in the noninvasive, initial diagnosis of giant cell arteritis.


To assess the diagnostic accuracy of contrast material–enhanced magnetic resonance (MR) imaging of superficial cranial arteries in the initial diagnosis of giant cell arteritis (GCA).

Materials and Methods

Following institutional review board approval and informed consent, 185 patients suspected of having GCA were included in a prospective three–university medical center trial. GCA was diagnosed or excluded clinically in all patients (reference standard [final clinical diagnosis]). In 53.0% of patients (98 of 185), temporal artery biopsy (TAB) was performed (diagnostic standard [TAB]). Two observers independently evaluated contrast-enhanced T1-weighted MR images of superficial cranial arteries by using a four-point scale. Diagnostic accuracy, involvement pattern, and systemic corticosteroid (sCS) therapy effects were assessed in comparison with the reference standard (total study cohort) and separately in comparison with the diagnostic standard TAB (TAB subcohort). Statistical analysis included diagnostic accuracy parameters, interobserver agreement, and receiver operating characteristic analysis.


Sensitivity of MR imaging was 78.4% and specificity was 90.4% for the total study cohort, and sensitivity was 88.7% and specificity was 75.0% for the TAB subcohort (first observer). Diagnostic accuracy was comparable for both observers, with good interobserver agreement (TAB subcohort, κ = 0.718; total study cohort, κ = 0.676). MR imaging scores were significantly higher in patients with GCA-positive results than in patients with GCA-negative results (TAB subcohort and total study cohort, P < .001). Diagnostic accuracy of MR imaging was high in patients without and with sCS therapy for 5 days or fewer (area under the curve, ≥0.9) and was decreased in patients receiving sCS therapy for 6–14 days. In 56.5% of patients with TAB-positive results (35 of 62), MR imaging displayed symmetrical and simultaneous inflammation of arterial segments.


MR imaging of superficial cranial arteries is accurate in the initial diagnosis of GCA. Sensitivity probably decreases after more than 5 days of sCS therapy; thus, imaging should not be delayed.

Clinical trial registration no. DRKS00000594

© RSNA, 2014


  • 1. Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ, et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum 2009;61(10):1454–1461. Crossref, MedlineGoogle Scholar
  • 2. Nuenninghoff DM, Hunder GG, Christianson TJH, McClelland RL, Matteson EL. Mortality of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis: a population-based study over 50 years. Arthritis Rheum 2003;48(12):3532–3537. Crossref, MedlineGoogle Scholar
  • 3. Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet 2008;372(9634):234–245. Crossref, MedlineGoogle Scholar
  • 4. Wilkinson IM, Russell RW. Arteries of the head and neck in giant cell arteritis: a pathological study to show the pattern of arterial involvement. Arch Neurol 1972;27(5):378–391. Crossref, MedlineGoogle Scholar
  • 5. Klein RG, Campbell RJ, Hunder GG, Carney JA. Skip lesions in temporal arteritis. Mayo Clin Proc 1976;51(8):504–510. MedlineGoogle Scholar
  • 6. Hunder GG, Bloch DA, Michel BA, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990;33(8):1122–1128. Crossref, MedlineGoogle Scholar
  • 7. Proven A, Gabriel SE, Orces C, O’Fallon WM, Hunder GG. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum 2003;49(5):703–708. Crossref, MedlineGoogle Scholar
  • 8. Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med 2002;347(4):261–271. Crossref, MedlineGoogle Scholar
  • 9. Bley TA, Uhl M, Carew J, et al. Diagnostic value of high-resolution MR imaging in giant cell arteritis. AJNR Am J Neuroradiol 2007;28(9):1722–1727. Crossref, MedlineGoogle Scholar
  • 10. Bley TA, Wieben O, Uhl M, Thiel J, Schmidt D, Langer M. High-resolution MRI in giant cell arteritis: imaging of the wall of the superficial temporal artery. AJR Am J Roentgenol 2005;184(1):283–287. Crossref, MedlineGoogle Scholar
  • 11. Bossuyt PM, Reitsma JB, Bruns DE, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD Initiative. Radiology 2003;226(1):24–28. LinkGoogle Scholar
  • 12. Pepe MS. The statistical evaluation of medical tests for classification and prediction. Oxford, England: Oxford University Press, 2003. Google Scholar
  • 13. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):159–174. Crossref, MedlineGoogle Scholar
  • 14. DeLong ER, Vernon WB, Bollinger RR. Sensitivity and specificity of a monitoring test. Biometrics 1985;41(4):947–958. Crossref, MedlineGoogle Scholar
  • 15. Bley TA, Weiben O, Uhl M, et al. Assessment of the cranial involvement pattern of giant cell arteritis with 3T magnetic resonance imaging. Arthritis Rheum 2005;52(8):2470–2477. Crossref, MedlineGoogle Scholar
  • 16. Ypsilantis E, Courtney ED, Chopra N, et al. Importance of specimen length during temporal artery biopsy. Br J Surg 2011;98(11):1556–1560. Crossref, MedlineGoogle Scholar
  • 17. Niederkohr RD, Levin LA. A Bayesian analysis of the true sensitivity of a temporal artery biopsy. Invest Ophthalmol Vis Sci 2007;48(2):675–680. Crossref, MedlineGoogle Scholar
  • 18. Alberts MS, Mosen DM. Diagnosing temporal arteritis: duplex vs. biopsy. QJM 2007;100(12):785–789. Crossref, MedlineGoogle Scholar
  • 19. Bley TA, Markl M, Schelp M, et al. Mural inflammatory hyperenhancement in MRI of giant cell (temporal) arteritis resolves under corticosteroid treatment. Rheumatology (Oxford) 2008;47(1):65–67. Crossref, MedlineGoogle Scholar
  • 20. Hauenstein C, Reinhard M, Geiger J, et al. Effects of early corticosteroid treatment on magnetic resonance imaging and ultrasonography findings in giant cell arteritis. Rheumatology (Oxford) 2012;51(11):1999–2003. Crossref, MedlineGoogle Scholar
  • 21. Takekawa H, Daimon Y, Takashima R, Aiba S, Tanaka H, Hirata K. Giant cell arteritis associated with lesion of the internal carotid artery: assessment of response to steroid therapy by magnetic resonance angiography. Intern Med 2008;47(13):1285–1286. Crossref, MedlineGoogle Scholar
  • 22. Bley TA, Ness T, Warnatz K, et al. Influence of corticosteroid treatment on MRI findings in giant cell arteritis. Clin Rheumatol 2007;26(9):1541–1543. Crossref, MedlineGoogle Scholar
  • 23. Narváez J, Bernad B, Roig-Vilaseca D, et al. Influence of previous corticosteroid therapy on temporal artery biopsy yield in giant cell arteritis. Semin Arthritis Rheum 2007;37(1):13–19. Crossref, MedlineGoogle Scholar

Article History

Received January 9, 2014; revision requested March 11; final revision received April 29; accepted May 20; final version accepted June 4.
Published online: Aug 06 2014
Published in print: Dec 2014