St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada, and Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.
Arthritis Rheumatol. 2017 Jan;69(1):161-168. doi: 10.1002/art.39824.
To examine the concordance between high-resolution magnetic resonance imaging (MRI) of the scalp arteries and temporal artery biopsy for the diagnosis of giant cell arteritis (GCA).
We conducted a prospective cohort study of patients with suspected GCA. Participants underwent high-field 3T MRI of the scalp arteries followed by temporal artery biopsy. Arterial wall thickness and enhancement on multiplanar postcontrast T1-weighted spin-echo images were graded according to a published severity scale (range 0-3). MRI findings were compared with temporal artery biopsy results and the American College of Rheumatology (ACR) criteria for GCA.
One hundred seventy-one patients were included in the study. Temporal artery biopsy findings were positive in 31 patients (18.1%), and MRI findings were abnormal in 60 patients (35.1%). ACR criteria were met in 137 patients (80.1%). With temporal artery biopsy as the reference test, MRI had a sensitivity of 93.6% (95% confidence interval [95% CI] 78.6-99.2) and a specificity of 77.9% (95% CI 70.1-84.4). The corresponding negative predictive value of MRI was 98.2% (95% CI 93.6-99.8) and positive predictive value was 48.3% (95% CI 35.2-61.6).
In patients with suspected GCA, normal findings on scalp artery MRI are very strongly associated with negative temporal artery biopsy findings. This suggests that MRI could be used as the initial diagnostic procedure in GCA, with temporal artery biopsy being reserved for patients with abnormal MRI findings.
研究头皮动脉高分辨率磁共振成像（MRI）与颞动脉活检在巨细胞动脉炎（GCA）诊断中的一致性。
我们对疑似 GCA 的患者进行了前瞻性队列研究。参与者接受头皮动脉高场 3T MRI 检查，然后进行颞动脉活检。根据已发表的严重程度量表（范围 0-3），对多平面对比后 T1 加权自旋回波图像上的动脉壁厚度和增强进行分级。将 MRI 结果与颞动脉活检结果和美国风湿病学会（ACR）GCA 标准进行比较。
研究共纳入 171 例患者。31 例（18.1%）患者的颞动脉活检结果阳性，60 例（35.1%）患者的 MRI 结果异常。137 例（80.1%）患者符合 ACR 标准。以颞动脉活检为参考试验，MRI 的敏感性为 93.6%（95%置信区间[95%CI]78.6-99.2），特异性为 77.9%（95%CI 70.1-84.4）。MRI 的阴性预测值为 98.2%（95%CI 93.6-99.8），阳性预测值为 48.3%（95%CI 35.2-61.6）。
在疑似 GCA 的患者中，头皮动脉 MRI 正常结果与颞动脉活检阴性结果密切相关。这表明 MRI 可作为 GCA 的初始诊断程序，仅将颞动脉活检保留用于 MRI 异常的患者。
