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High-Resolution 3T MR Scalp Vessel Wall Imaging in Giant Cell Arteritis: a Useful Tool

Published online by Cambridge University Press:  05 May 2021

Benjamin Y.M. Kwan*
Affiliation:
Department of Radiology, Queen’s University
Omar Islam
Affiliation:
Department of Radiology, Queen’s University
Donatella Tampieri
Affiliation:
Department of Radiology, Queen’s University
Martin ten Hove
Affiliation:
Department of Opthalmology, Queen’s University
*
Correspondence to: Benjamin Yin Ming Kwan MD, FRCPC, DABR, Assistant Professor, CBME Lead/Assistant Program Director, Diagnostic Radiology Residency Program, Faculty Research Director – Department of Radiology, Queen’s University. Email: [email protected]
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Abstract

Type
Neuroimaging Highlight
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

A 68-year-old female presents with recent onset of bilateral sequential no-light-perception vision secondary to presumed giant cell arteritis. The patient had markedly elevated CRP/ESR (CRP 51.2 mg/L (normal <1 mg/L) and ESR > 130 mm/hr (normal <30 mm/hr)). The patient received IV methylprednisolone. Neither temporal artery could be palpated. Only the preauricular portion of the right temporal artery had a faint pulse and a biopsy in this area was deemed unsafe due to the risk of facial nerve injury. Reference Shin, Shin, Lee, Koh and Song1 On ultrasound, the arteries were nonaudible. High-resolution scalp vessel wall magnetic resonance (MR) imaging at 3T was subsequently performed and demonstrated enhancement and thickening of the wall in the proximal segment of the right superficial temporal artery which was congruent with a diagnosis of giant cell arteritis. Immediate treatment with prednisone led to improvement of her constitutional symptoms; however, she had no significant recovery of vision. High-resolution scalp vessel wall MR imaging is a recently developed technique that has been applied to the diagnosis of giant cell arteritis. Reference Rheaume, Rebello and Pagnoux2,Reference Poillon, Collin and Benhamou3 Wall thickening and enhancement of the scalp arteries are key imaging features for the diagnosis of giant cell arteritis. Reference Rheaume, Rebello and Pagnoux2 Usage of 3D techniques rather than 2D techniques has also been shown to increase sensitivity. Reference Poillon, Collin and Benhamou3 Scalp vessel wall MR imaging can be helpful in cases precluded from temporal artery biopsy for the confirmation of diagnosis (Figure 1).

Figure 1: Pre- (A1–A3) and post- (B1–B3) contrast high-resolution MR 3D T1 FS Black Blood Images of the scalp vessels (in axial, coronal, and sagittal planes) demonstrate enhancement and thickening of the wall in the proximal segment of the right superficial temporal artery (arrow) in the region of palpable pulse.

Disclosures

The authors have no conflicts of interest to declare.

Statement of Authorship

BK, OI, DT, and MtH wrote and edited the manuscript.

References

Shin, K, Shin, HJ, Lee, S, Koh, K, Song, W. Surgical anatomy of the superficial temporal artery to prevent facial nerve injury during arterial biopsy. Clin Anat 2018;31:608–13.CrossRefGoogle ScholarPubMed
Rheaume, M, Rebello, R, Pagnoux, C, et al. High-resolution magnetic resonance imaging of scalp arteries for diagnosis of giant cell arteritis: results of a prospective cohort study. Arthritis Rheumatol 2017;69:161–68.CrossRefGoogle ScholarPubMed
Poillon, G, Collin, A, Benhamou, Y, et al. Increased diagnostic accuracy of giant cell arteritis using three-dimensional fat-saturated contrast-enhanced vessel-wall magnetic resonance imaging at 3T. Eur Radiol 2020;30:1866–75.CrossRefGoogle Scholar
Figure 0

Figure 1: Pre- (A1–A3) and post- (B1–B3) contrast high-resolution MR 3D T1 FS Black Blood Images of the scalp vessels (in axial, coronal, and sagittal planes) demonstrate enhancement and thickening of the wall in the proximal segment of the right superficial temporal artery (arrow) in the region of palpable pulse.