Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

Abstract

Early recognition of giant cell arteritis (GCA) is crucial to avoid the development of ischemic vascular complications, such as blindness. The classic approach to making the diagnosis of GCA is based on a positive temporal artery biopsy, which is among the criteria proposed by the American College of Rheumatology (ACR) in 1990 to classify a patient as having GCA. However, imaging techniques, particularly ultrasound (US) of the temporal arteries, are increasingly being considered as an alternative for the diagnosis of GCA. Recent recommendations from the European League Against Rheumatism (EULAR) for the use of imaging techniques for large vessel vasculitis (LVV) included US as the first imaging option for the diagnosis of GCA. Furthermore, although the ACR classification criteria are useful in identifying patients with the classic cranial pattern of GCA, they are often inadequate in identifying GCA patients who have the extracranial phenotype of LVV. In this sense, the advent of other imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET)/CT, has made it possible to detect the presence of extracranial involvement of the LVV in patients with GCA presenting as refractory rheumatic polymyalgia without cranial ischemic manifestations. Imaging techniques have been the key elements in redefining the diagnostic work-up of GCA. US is currently considered the main imaging modality to improve the early diagnosis of GCA.

Diagnostic performance of 18F‐FDG‐PET/CT in inflammation of unknown origin: A clinical series of 317 patients

“…The 18 F-FDG-PET/CT was contributory in 75% of IUO patients, highlighting its helpfulness in investigating IUO [5,6]. This diagnostic contribution for the two leading causes of NIID in IUO, GCA, and PMR supports the published literature [14][15][16][17].…”

Polymyalgia rheumatica: when should we suspect an underlying large vessel vasculitis?

“…Meanwhile, we proposed potential red flags for suspected LV vasculitis in patients with isolated PMR (Table I). In patients with these characteristics, imaging techniques can be considered, especially US and PET/CT (20). Furthermore, since severe ischemic manifestations of GCA can occur in patients who present as isolated PMR, we recommend periodic evaluation of patients with PMR for early identification of the onset of ischemic manifestations of GCA.…”

Ocular Complications of Giant Cell Arteritis: An Acute Therapeutic Emergency

“…Ultrasonography (US) and MRI of the superficial temporal artery showed the best performances in cranial GCA, with estimated pooled sensitivities in the main studies of respectively 77% and 73%, and pooled specificities of 96% and 88% [ 40 ]. US of temporal arteries has been recommended as first line imaging in patients with suspected predominantly cranial GCA and is the pivotal examination in fast-track diagnostic centers that developed recently [ 41 ]. In two retrospective studies comparing a fast-track approach including US of temporal and axillary arteries to conventional clinical practice, the accelerated procedure has been associated with a significantly lower rate of visual loss [ 42 , 43 ].…”