Temporal arteritis: giant cell arteritis

Case contributed by Dr Christoph Berliner

Presentation

Patient with suspicion of Giant cell arteritis and recently new diagnosed headaches. No anti-inflammatory treatment. Regular ophthalmologic state.

Patient Data

Age: 73
Gender: Male
MRI

High resolution MRI of temporal artery and regular thoracic angiography

Axial T1C+ fs scan of the extracranial arteries with mural thickening and bilateral mural contrast enhancement of  the superficial temporal artery.

Also a slight sinusitis is shown.

Normal presentation of the thoracic vessels.

Case Discussion

Giant cell arteriitis (GCA) with typical affection of the superficial temporary artery is within a standard European population the most commonest vasculitis. Thus biopsy is the so called "gold standard", assessment with high resolution contrast enhanced and fat saturated T1- MRI is possible and can also be used for monitoring within anti-inflammatory / immunsuppressive therapy. Especially MRI allows simultaneously assesment of all superficial artery segments.

 A symmetrical and simultaneous vascular inflammation of superficial cranial arteries is the typical involvement pattern. MRI imaging sings may vanish after 5-7 days of systemic anti-inflammatory therapy with steroids.

For ranking of mural contrast enhancement, the following four-point scale proposed by Bley et. al. can be used:

-, no enhancement; +, slight mural enhancement; ++, prominent mural enhancement; and +++, strong mural enhancement, including perivascular tissue.

For the wall thickness the cuttoff between unaffected and inflamed arteries 0.6 to 0.7 mm.

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Case information

rID: 27998
Case created: 3rd Mar 2014
Last edited: 26th Sep 2015
System: Head & Neck
Inclusion in quiz mode: Included

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