Seitz Luca, Bucher Susana, Bütikofer Lukas, Maurer Britta, Bonel Harald M, Wagner Franca, Lötscher Fabian, Seitz Pascal
Department of Rheumatology and Immunology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
CTU Bern, University of Bern, Bern, Switzerland.
Rheumatology (Oxford). 2024 May 2;63(5):1403-1410. doi: 10.1093/rheumatology/kead401.
To investigate the diagnostic performance of diffusion-weighted imaging (DWI) of the superficial cranial arteries in the diagnosis of GCA.
Retrospectively, 156 patients with clinically suspected GCA were included. A new 4-point ordinal DWI rating scale was developed. A post-contrast, fat-suppressed, T1-weighted 'black-blood' sequence (T1-BB) was rated for comparison. Ten arterial segments were assessed: common superficial temporal arteries, temporal and parietal branches, occipital and posterior auricular arteries bilaterally. The expert clinical diagnosis after ≥6 months of follow-up was the diagnostic reference standard. Diagnostic accuracy was evaluated for different rating methods.
The study cohort consisted of 87 patients with and 69 without GCA. For DWI, the area under the curve was 0.90. For a cut-off of ≥2 consecutive pathological slices, DWI showed a sensitivity of 75.9%, a specificity of 94.2% and a positive likelihood ratio of 13.09. With a cut-off of ≥3 consecutive pathological slices, sensitivity was 70.1%, specificity was 98.6% and the positive likelihood ratio was 48.38. For the T1-BB, values were 88.5%, 88.4% and 7.63, respectively. The inter-rater analysis for DWI with a cut-off of ≥2 pathological slices showed a kappa of 1.00 on the patient level and 0.85 on the arterial segment level. For the T1-BB the kappa was 0.78 and 0.79, respectively.
DWI of the superficial cranial arteries demonstrates a good diagnostic accuracy and reliability for the diagnosis of GCA. DWI is widely available and can be used immediately in clinical practice for patients with suspected GCA.
探讨颅外动脉扩散加权成像（DWI）在巨细胞动脉炎（GCA）诊断中的诊断效能。
回顾性纳入156例临床疑似GCA的患者。制定了一种新的4分序贯DWI评分量表。对增强后脂肪抑制T1加权“黑血”序列（T1-BB）进行评分以作比较。评估10个动脉节段：双侧颞浅动脉主干、颞支和顶支、枕动脉和耳后动脉。随访≥6个月后的专家临床诊断为诊断参考标准。对不同评分方法的诊断准确性进行评估。
研究队列包括87例GCA患者和69例非GCA患者。对于DWI，曲线下面积为0.90。对于连续≥2个病理切片的截断值，DWI的敏感性为75.9%，特异性为94.2%，阳性似然比为13.09。对于连续≥3个病理切片的截断值，敏感性为70.1%，特异性为98.6%，阳性似然比为48.38。对于T1-BB，相应值分别为88.5%、88.4%和7.63。对于截断值为≥2个病理切片的DWI，观察者间分析在患者水平的kappa值为1.00，在动脉节段水平为0.85。对于T1-BB，kappa值分别为0.78和0.79。
颅外动脉DWI对GCA的诊断具有良好的诊断准确性和可靠性。DWI广泛可用，可立即用于疑似GCA患者的临床实践。
