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

Published Online:https://doi.org/10.1148/radiol.14140056

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

Purpose

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.

Results

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.

Conclusion

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

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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