Giant Cell Arteritis Imaging

Updated: Jun 08, 2016
  • Author: Guruswami Giri, MD, FRCS; Chief Editor: Kyung J Cho, MD, FACR, FSIR  more...
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Overview

Overview

Giant cell arteritis is a systemic obliterative vasculitis mainly involving the arteries that originate from the arch of aorta. However, any vessel in the body can be affected. The inflammation is a necrotizing obliterative vasculitis of large and medium-sized vessels. [1]

The superficial temporal, vertebral, ophthalmic, and posterior ciliary arteries are more commonly affected than the internal and external carotid arteries. Intracranial arteries other than those involving the orbits are less commonly affected. Cases involving the proximal distal aorta and the subclavian and abdominal arteries have been reported. The inflammation is segmental, and therefore, skip lesions are seen in giant cell arteritis. [2]

Giant cell arteritis is a disease of elderly persons, the incidence of which increases with increasing age. The mean age of onset is 70 years.

For excellent patient education resources, see eMedicineHealth's patient education article Phlebitis.

Preferred examination

Color Doppler ultrasonography is a method for assessing blood flow qualitatively and quantitatively. In the presence of arteritis, the sonograms show a hypoechoic halo due to edema of the arterial wall. [3] The sensitivity and specificity of this finding are not well established.

The advantages of this technique are that it is simple, it is noninvasive, and it can be used to examine several vessels, superficial and deep. Another advantage of this technique is that follow-up scans can be obtained to assess the response to steroids. The hypoechoic shadow becomes mid echoic in about 2 weeks. With fibrosis, the shadow becomes hyperechoic. [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]

Other nonradiologic investigations include a determination of the blood sedimentation rate and temporal artery biopsy (see the images below). [15] The criterion standard is the temporal artery biopsy.

CT is not useful in diagnosing giant cell arteritis. However, CT may be used to diagnose complications due to giant cell arteritis, such as a CVA.

MRI is not useful in diagnosing giant cell arteritis. However, MRI may be used to diagnose complications due to giant cell arteritis, such as a CVA.

Giant cell arteritis. Low-power view of a temporal Giant cell arteritis. Low-power view of a temporal artery biopsy sample shows giant cell arteritis.
Giant cell arteritis. Low-power view of a normal t Giant cell arteritis. Low-power view of a normal temporal artery biopsy sample.
Giant cell arteritis. High-power view shows disrup Giant cell arteritis. High-power view shows disruption of the intima with a collection of multinucleated giant cells.

Limitations of techniques

The criterion used to diagnose giant cell arteritis with color Doppler ultrasonography is the presence of a halo sign. This is not seen in all patients, and it may also be seen in healthy persons. The halo has also been reported in polyarteritis nodosa. Therefore, the criterion standard is the temporal artery biopsy.

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Ultrasonography

Color Doppler ultrasonography is a method of assessing blood flow qualitatively and quantitatively.

In the presence of arteritis, the sonograms show a hypoechoic halo due to edema of the arterial wall. The sensitivity and specificity of this finding is not well established. Findings of Doppler color flow ultrasonography may be normal in patients with giant cell arteritis.

The advantages of this technique are that it is simple, it is noninvasive, and it can be used to examine several vessels, superficial and deep. Another advantage of this technique is that follow-up scans can be obtained to assess the response to steroids. The hypoechoic shadow becomes mid echoic in about 2 weeks. With fibrosis, the shadow becomes hyperechoic.

A high positive and negative predictive value of arteritis on color duplex ultrasound indicates that temporal artery biopsy may not be necessary in suspected giant cell arteritis, particularly in cases in which clinical suspicion of giant cell arteritis is high or low. [13]

The criterion used to diagnose giant cell arteritis with color Doppler ultrasonography is the presence of a halo sign. The specificity and sensitivity of this sign is not well established. This is not present in all patients, and it may also be seen in healthy persons. The halo has also been reported in polyarteritis nodosa. Therefore, the criterion standard is temporal artery biopsy.

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