Magnetic resonance angiography in extracranial giant cell arteritis.

Marcel Koenigkam-Santos, Puneet Sharma, Bobby T Kalb, John N. Oshinski, Cornelia M. Weyand, Jörg J. Goronzy, Diego R Martin

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Noninvasive diagnosis of giant cell arteritis (GCA) remains challenging, particularly with regard to evaluation of extracranial arterial disease. The objective of the study was to retrospectively review extracranial involvement in patients with GCA and/or polymyalgia rheumatica (PMR), evaluated with magnetic resonance imaging (MRI), especially 3-dimensional contrast-enhanced magnetic resonance angiography images of the aortic arch and its branches. Clinical information, biopsy status, and MRI examinations of 28 patients with GCA/PMR were reviewed. Patient images were mixed randomly with 20 normal control images and were independently reviewed by 2 radiologists. Interobserver agreement for detection of arterial stenosis was determined by the k coefficient. Both readers described vascular alterations in keeping with extracranial GCA in 19 of 28 patients (67%) with good interobserver agreement (k = 0.73) and with even higher agreement on diagnosing nonocclusive versus occlusive disease (k = 1.00). The most common lesions were bilateral axillary stenosis or obstructions, observed by both readers in 8 patients (28%). Among the 19 patients with magnetic resonance angiography lesions in the subclavian/axillary arteries, 12 (75%) had biopsy-proven GCA, but only 5 (41%) of these patients had clinical features of large artery disease. In our series review, MRI could provide accurate information on involvement of the aortic arch and its branches in extracranial GCA, depicting different degrees of stenosis. Our analysis also illustrates that occult large artery vasculitis should be considered in patients without biopsy-proven GCA, patients with classic GCA but without clinical signs of large artery disease, and in patients initially diagnosed as having PMR.

Original languageEnglish (US)
Pages (from-to)306-310
Number of pages5
JournalJournal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
Volume17
Issue number6
StatePublished - Sep 2011
Externally publishedYes

Fingerprint

Giant Cell Arteritis
Magnetic Resonance Angiography
Polymyalgia Rheumatica
Pathologic Constriction
Arteries
Magnetic Resonance Imaging
Thoracic Aorta
Biopsy
Axillary Artery
Subclavian Artery
Vasculitis
Blood Vessels

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Magnetic resonance angiography in extracranial giant cell arteritis. / Koenigkam-Santos, Marcel; Sharma, Puneet; Kalb, Bobby T; Oshinski, John N.; Weyand, Cornelia M.; Goronzy, Jörg J.; Martin, Diego R.

In: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, Vol. 17, No. 6, 09.2011, p. 306-310.

Research output: Contribution to journalArticle

Koenigkam-Santos, Marcel ; Sharma, Puneet ; Kalb, Bobby T ; Oshinski, John N. ; Weyand, Cornelia M. ; Goronzy, Jörg J. ; Martin, Diego R. / Magnetic resonance angiography in extracranial giant cell arteritis. In: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases. 2011 ; Vol. 17, No. 6. pp. 306-310.
@article{178f79538ef94fd9a4ec1932b9e09aed,
title = "Magnetic resonance angiography in extracranial giant cell arteritis.",
abstract = "Noninvasive diagnosis of giant cell arteritis (GCA) remains challenging, particularly with regard to evaluation of extracranial arterial disease. The objective of the study was to retrospectively review extracranial involvement in patients with GCA and/or polymyalgia rheumatica (PMR), evaluated with magnetic resonance imaging (MRI), especially 3-dimensional contrast-enhanced magnetic resonance angiography images of the aortic arch and its branches. Clinical information, biopsy status, and MRI examinations of 28 patients with GCA/PMR were reviewed. Patient images were mixed randomly with 20 normal control images and were independently reviewed by 2 radiologists. Interobserver agreement for detection of arterial stenosis was determined by the k coefficient. Both readers described vascular alterations in keeping with extracranial GCA in 19 of 28 patients (67{\%}) with good interobserver agreement (k = 0.73) and with even higher agreement on diagnosing nonocclusive versus occlusive disease (k = 1.00). The most common lesions were bilateral axillary stenosis or obstructions, observed by both readers in 8 patients (28{\%}). Among the 19 patients with magnetic resonance angiography lesions in the subclavian/axillary arteries, 12 (75{\%}) had biopsy-proven GCA, but only 5 (41{\%}) of these patients had clinical features of large artery disease. In our series review, MRI could provide accurate information on involvement of the aortic arch and its branches in extracranial GCA, depicting different degrees of stenosis. Our analysis also illustrates that occult large artery vasculitis should be considered in patients without biopsy-proven GCA, patients with classic GCA but without clinical signs of large artery disease, and in patients initially diagnosed as having PMR.",
author = "Marcel Koenigkam-Santos and Puneet Sharma and Kalb, {Bobby T} and Oshinski, {John N.} and Weyand, {Cornelia M.} and Goronzy, {J{\"o}rg J.} and Martin, {Diego R}",
year = "2011",
month = "9",
language = "English (US)",
volume = "17",
pages = "306--310",
journal = "Journal of Clinical Rheumatology",
issn = "1076-1608",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Magnetic resonance angiography in extracranial giant cell arteritis.

AU - Koenigkam-Santos, Marcel

AU - Sharma, Puneet

AU - Kalb, Bobby T

AU - Oshinski, John N.

AU - Weyand, Cornelia M.

AU - Goronzy, Jörg J.

AU - Martin, Diego R

PY - 2011/9

Y1 - 2011/9

N2 - Noninvasive diagnosis of giant cell arteritis (GCA) remains challenging, particularly with regard to evaluation of extracranial arterial disease. The objective of the study was to retrospectively review extracranial involvement in patients with GCA and/or polymyalgia rheumatica (PMR), evaluated with magnetic resonance imaging (MRI), especially 3-dimensional contrast-enhanced magnetic resonance angiography images of the aortic arch and its branches. Clinical information, biopsy status, and MRI examinations of 28 patients with GCA/PMR were reviewed. Patient images were mixed randomly with 20 normal control images and were independently reviewed by 2 radiologists. Interobserver agreement for detection of arterial stenosis was determined by the k coefficient. Both readers described vascular alterations in keeping with extracranial GCA in 19 of 28 patients (67%) with good interobserver agreement (k = 0.73) and with even higher agreement on diagnosing nonocclusive versus occlusive disease (k = 1.00). The most common lesions were bilateral axillary stenosis or obstructions, observed by both readers in 8 patients (28%). Among the 19 patients with magnetic resonance angiography lesions in the subclavian/axillary arteries, 12 (75%) had biopsy-proven GCA, but only 5 (41%) of these patients had clinical features of large artery disease. In our series review, MRI could provide accurate information on involvement of the aortic arch and its branches in extracranial GCA, depicting different degrees of stenosis. Our analysis also illustrates that occult large artery vasculitis should be considered in patients without biopsy-proven GCA, patients with classic GCA but without clinical signs of large artery disease, and in patients initially diagnosed as having PMR.

AB - Noninvasive diagnosis of giant cell arteritis (GCA) remains challenging, particularly with regard to evaluation of extracranial arterial disease. The objective of the study was to retrospectively review extracranial involvement in patients with GCA and/or polymyalgia rheumatica (PMR), evaluated with magnetic resonance imaging (MRI), especially 3-dimensional contrast-enhanced magnetic resonance angiography images of the aortic arch and its branches. Clinical information, biopsy status, and MRI examinations of 28 patients with GCA/PMR were reviewed. Patient images were mixed randomly with 20 normal control images and were independently reviewed by 2 radiologists. Interobserver agreement for detection of arterial stenosis was determined by the k coefficient. Both readers described vascular alterations in keeping with extracranial GCA in 19 of 28 patients (67%) with good interobserver agreement (k = 0.73) and with even higher agreement on diagnosing nonocclusive versus occlusive disease (k = 1.00). The most common lesions were bilateral axillary stenosis or obstructions, observed by both readers in 8 patients (28%). Among the 19 patients with magnetic resonance angiography lesions in the subclavian/axillary arteries, 12 (75%) had biopsy-proven GCA, but only 5 (41%) of these patients had clinical features of large artery disease. In our series review, MRI could provide accurate information on involvement of the aortic arch and its branches in extracranial GCA, depicting different degrees of stenosis. Our analysis also illustrates that occult large artery vasculitis should be considered in patients without biopsy-proven GCA, patients with classic GCA but without clinical signs of large artery disease, and in patients initially diagnosed as having PMR.

UR - http://www.scopus.com/inward/record.url?scp=84857430575&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857430575&partnerID=8YFLogxK

M3 - Article

C2 - 21869711

AN - SCOPUS:84857430575

VL - 17

SP - 306

EP - 310

JO - Journal of Clinical Rheumatology

JF - Journal of Clinical Rheumatology

SN - 1076-1608

IS - 6

ER -