Kern Daria, Bley Thorsten A, Riedling Lukas, Fröhlich Matthias, Hillenkamp Jost, Gernert Michael, Schmalzing Marc, Werner Rudolf A, Guggenberger Konstanze V
Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany.
Department of Internal Medicine II, Rheumatology and Clinical Immunology, University Hospital Wuerzburg, Wuerzburg, Germany.
Rheumatology (Oxford). 2025 Aug 1;64(8):4750-4755. doi: 10.1093/rheumatology/keaf169.
To evaluate the incremental value of contrast-enhanced vascular MRI for also detecting inflammatory musculoskeletal manifestations in patients with GCA-PMR spectrum disease (GPSD).
T1-weighted contrast-enhanced volume interpolated breath-hold examination (VIBE)-sequences of the torso of 78 patients with clinically confirmed GPSD, acquired for vessel wall imaging of the aorta, were retrospectively evaluated for signs of inflammation in the glenohumeral synovium, long biceps and subscapularis tendons, supra-/interspinous ligaments, and for shoulder joint effusion. Two experienced radiologists and two inexperienced readers assessed the images independently. Inter-rater reliability between experienced and inexperienced readers was calculated.
Forty-nine percent of the patients were diagnosed with GCA only, 28% with PMR only, and 23% with both GCA and PMR (GCA-PMR). Musculoskeletal inflammation was predominantly bilaterally symmetrical. Glenohumeral synovitis was found in 35% of all patients, shoulder joint effusion in 6%, long biceps tendon enhancement in 26%, subscapularis tendon enhancement in 42% and supra-/interspinous ligament enhancement in 29%. Patients with PMR showed inflammatory signs at a higher percentage compared with those with GCA or GCA-PMR. Fleiss's kappa indicated almost perfect agreement among readers for supra-/interspinous ligament and subscapularis tendon assessments.
Fifty-one percent of the GPSD patients showed signs of inflammation in at least one of the evaluated musculoskeletal structures on contrast-enhanced MRI, with the subscapularis tendon being the most frequently affected. A contrast-enhanced T1-weighted VIBE sequence provides a fast one-stop solution for assessing inflammatory wall changes of the aorta while simultaneously visualizing inflammation-suspect changes in the musculoskeletal structures of the torso within a reasonable examination time.
评估对比增强血管磁共振成像（MRI）对于检测巨细胞动脉炎-风湿性多肌痛谱疾病（GPSD）患者肌肉骨骼炎症表现的增量价值。
对78例临床确诊的GPSD患者的躯干进行T1加权对比增强容积内插屏气检查（VIBE）序列成像，用于主动脉血管壁成像，回顾性评估盂肱关节滑膜、肱二头肌长头和肩胛下肌腱、棘上/棘间韧带的炎症迹象以及肩关节积液情况。两名经验丰富的放射科医生和两名经验不足的阅片者独立评估图像。计算经验丰富和经验不足的阅片者之间的评分者间可靠性。
49%的患者仅被诊断为巨细胞动脉炎，28%仅被诊断为风湿性多肌痛，23%同时患有巨细胞动脉炎和风湿性多肌痛（巨细胞动脉炎-风湿性多肌痛）。肌肉骨骼炎症主要为双侧对称。在所有患者中，35%发现盂肱关节滑膜炎，6%发现肩关节积液，26%发现肱二头肌长头肌腱强化，42%发现肩胛下肌腱强化，29%发现棘上/棘间韧带强化。与巨细胞动脉炎或巨细胞动脉炎-风湿性多肌痛患者相比，风湿性多肌痛患者出现炎症体征的比例更高。Fleiss卡方检验表明，阅片者在棘上/棘间韧带和肩胛下肌腱评估方面几乎完全一致。
51%的GPSD患者在对比增强MRI上至少一个评估的肌肉骨骼结构中显示炎症迹象，其中肩胛下肌腱受影响最为频繁。对比增强T1加权VIBE序列为评估主动脉炎症壁变化提供了一种快速一站式解决方案，同时在合理的检查时间内可视化躯干肌肉骨骼结构中可疑的炎症变化。
