eMedicine Specialties > Radiology > Vascular/Interventional

Temporal Arteritis: Imaging

Author: Anthony W Allen, MD, Chief, Interventional Radiology, Brooke Army Medical Center; Associate Professor of Radiology, Uniformed Services University of the Health Sciences
Coauthor(s): Timothy Biega, MD, Staff Physician, Department of Radiology, Tripler Regional Medical Center; Manish K Varma, MD, Chief of Interventional Radiology, Department of Radiology, Tripler Army Medical Center
Contributor Information and Disclosures

Updated: Oct 2, 2008

Radiography

Findings

Radiographs are of no use in diagnosing temporal arteritis.

Computed Tomography

Findings

Thickening of the arterial walls, stenosis, or occlusion may be demonstrated on contrast-enhanced CT scans.

Degree of Confidence

The findings can be observed in a variety of other disease processes.

False Positives/Negatives

CT commonly fails to depict mild inflammatory changes in the vessels. CT is not useful for the evaluation of small-vessel disease. In older persons, disease processes such as atherosclerotic disease are far more common than temporal arteritis and may result in similar CT findings.

Magnetic Resonance Imaging

Findings

MRI findings for temporal arteritis (giant cell arteritis) include loss of the normal flow void in affected vessels from occlusion or slow flow associated with disease. Enhancement of the arterial wall may be observed after the administration of gadolinium-based contrast material.22,23,24 Magnetic resonance angiography (MRA) may also demonstrate stenoses, irregularity of the vessel wall, and beading or thickening of the vessel wall.

Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans. 

NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory or Medscape.

Degree of Confidence

The findings can be observed in a variety of other disease processes.

False Positives/Negatives

MRI commonly will miss mild inflammatory changes of vessels. MRI is not useful for the evaluation of small-vessel disease. In the elderly, disease processes such as atherosclerotic disease are far more common than temporal arteritis and may result in similar MRI findings.

Ultrasonography

Findings

Ultrasonography can be used to evaluate small vessels such as the temporal arteries. Findings include stenoses and occlusion of the vessels. A characteristic hypoechoic halo has been described as surrounding the affected vessel that disappears after corticosteroid therapy. Ultrasonography is also useful in guiding biopsy.

Degree of Confidence

These findings can be observed with a variety of other disease processes. Findings may be negative in patients with minimal involvement of the temporal arteries. Ultrasonography cannot be used to evaluate vessels such as intrathoracic arteries that are more amenable to angiography or MRI.

False Positives/Negatives

Though unusual, atherosclerotic disease involving the temporal arteries may have an appearance similar to that of temporal arteritis. Minimally involved vessels may appear normal.

Nuclear Imaging

Findings

Positron emission tomography (PET) scanning has been used to evaluate unusual involvement that cannot be evaluated by means of surgical biopsy or ultrasonography.

Degree of Confidence

PET cannot be used to distinguish between the increased uptake observed with temporal arteritis and that observed in polymyalgia rheumatica.

Angiography

Findings

Angiography is an invasive test with inherent risks associated with the procedure and with the administration of contrast material. Findings consist of the involvement of small-to-moderate vessels. Angiography can demonstrate areas of constriction, beading, and microaneurysm formation that are fairly specific for temporal arteritis (giant cell arteritis). The occlusion of vessels and stenoses that are amenable to treatment may also be observed.

The most common sites for abnormalities to occur anatomically and on imaging studies are in the distal subclavian, proximal axillary, brachial, brachiocephalic, and femoral arteries. Atherosclerotic disease is a common finding in the older population; however, narrowings observed with atherosclerotic disease are typically short, segmental, and irregular, whereas stenoses in temporal arteritis are smooth, long, segmental, and tapered.

Degree of Confidence

Similar findings may be observed in patients with Takayasu arteritis and in those with atherosclerotic disease. Temporal artery biopsy is more definitive than angiography, and it can be guided by the arteriographic findings.

False Positives/Negatives

False-negative results may occur in a few patients in whom the temporal arteries are not well visualized.

More on Temporal Arteritis

Overview: Temporal Arteritis
Imaging: Temporal Arteritis
Follow-up: Temporal Arteritis
References
Further Reading
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References

  1. Danesh-Meyer HV, Savino PJ. Giant cell arteritis. Curr Opin Ophthalmol. Nov 2007;18(6):443-9. [Medline].

  2. Schmidt WA. Takayasu and temporal arteritis. Front Neurol Neurosci. 2006;21:96-104. [Medline].

  3. Tatò F, Hoffmann U. Giant cell arteritis: a systemic vascular disease. Vasc Med. 2008;13(2):127-40. [Medline].

  4. Tehrani R, Ostrowski RA, Hariman R, Jay WM. Giant cell arteritis. Semin Ophthalmol. Mar-Apr 2008;23(2):99-110. [Medline].

  5. Cantini F, Niccoli L, Nannini C, Bertoni M, Salvarani C. Diagnosis and treatment of giant cell arteritis. Drugs Aging. 2008;25(4):281-97. [Medline].

  6. Thielen KR, Wijdicks EF, Nichols DA. Giant cell (temporal) arteritis: involvement of the vertebral and internal carotid arteries. Mayo Clin Proc. May 1998;73(5):444-6. [Medline].

  7. Elliott PD, Baker HL Jr, Brown AL Jr. The superficial temporal artery angiogram. Radiology. Mar 1972;102(3):635-8. [Medline].

  8. Hunder GG, Arend WP, Bloch DA. The American College of Rheumatology 1990 criteria for the classification of vasculitis. Introduction. Arthritis Rheum. Aug 1990;33(8):1065-7. [Medline].

  9. Matteson EL, Gold KN, Bloch DA. Long-term survival of patients with giant cell arteritis in the American College of Rheumatology giant cell arteritis classification criteria cohort. Am J Med. Feb 1996;100(2):193-6. [Medline].

  10. Devauchelle-Pensec V, Jousse S, Destombe C, Saraux A. Epidemiology, imaging, and treatment of giant cell arteritis. Joint Bone Spine. May 2008;75(3):267-72. [Medline].

  11. Melson MR, Weyand CM, Newman NJ, Biousse V. The diagnosis of giant cell arteritis. Rev Neurol Dis. Summer 2007;4(3):128-42. [Medline].

  12. Dellaripa PF, Eisenhauer AC. Bilateral percutaneous balloon angioplasty of the axillary arteries in a patient with giant cell arteritis and upper extremity ischemic symptoms not responsive to corticosteroids. J Rheumatol. Jul 1998;25(7):1429-33. [Medline].

  13. Botella-Estrada R, Sammartin O, Martinez V. Magnetic resonance angiography in the diagnosis of a case of giant cell arteritis manifesting as scalp necrosis. Arch Dermatol. Jul 1999;135(7):769-71. [Medline].

  14. Harada S, Mitsunobu F, Kodama F. Giant cell arteritis associated with rheumatoid arthritis monitored by magnetic resonance angiography. Intern Med. Aug 1999;38(8):675-8. [Medline].

  15. Mitomo T, Funyu T, Takahashi Y. Giant cell arteritis and magnetic resonance angiography. Arthritis Rheum. Sep 1998;41(9):1702. [Medline].

  16. Schmidt WA, Kraft HE, Vorpahl K. Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med. Nov 6 1997;337(19):1336-42. [Medline].

  17. Myers KA, Farquhar DR. Ultrasonography in temporal arteritis. N Engl J Med. Mar 12 1998;338(11):760; discussion 761. [Medline].

  18. Schmidt WA, Kraft HE, Borkowski A. Color duplex ultrasonography in large-vessel giant cell arteritis. Scand J Rheumatol. 1999;28(6):374-6. [Medline].

  19. Hunder GG, Weyand CM. Sonography in giant-cell arteritis. N Engl J Med. Nov 6 1997;337(19):1385-6. [Medline].

  20. Puechal X, Chauveau M, Menkes CJ. Temporal Doppler-flow studies for suspected giant-cell arteritis. Lancet. Jun 3 1995;345(8962):1437-8. [Medline].

  21. Blockmans D, Stroobants S, Maes A. Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med. Feb 15 2000;108(3):246-9. [Medline].

  22. Anders HJ, Sigl T, Sander A. Gadolinium contrast magnetic resonance imaging of the temporal artery in giant cell arteritis. J Rheumatol. Oct 1999;26(10):2287-8. [Medline].

  23. Bley TA, Uhl M, Carew J, Markl M, Schmidt D, Peter HH, et al. Diagnostic value of high-resolution MR imaging in giant cell arteritis. AJNR Am J Neuroradiol. Oct 2007;28(9):1722-7. [Medline].

  24. Khoury JA, Hoxworth JM, Mazlumzadeh M, Wellik KE, Wingerchuk DM, Demaerschalk BM. The Clinical Utility of High Resolution Magnetic Resonance Imaging in the Diagnosis of Giant Cell Arteritis: A Critically Appraised Topic. Neurologist. Sep 2008;14(5):330-335. [Medline].

  25. Nesher G, Sonnenblick M, Friedlander Y. Analysis of steroid related complications and mortality in temporal arteritis: a 15-year survey of 43 patients. J Rheumatol. Jul 1994;21(7):1283-6. [Medline].

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Further Reading

Related eMedicine topics

 Temporal (Giant Cell) Arteritis  (Dermatology)

Temporal Arteritis  (Emergency Medicine)

Temporal/Giant Cell Arteritis  (Neurology)

Giant Cell Arteritis  (Ophthalmology)

Arteritis, Giant Cell  (Radiology)

Giant Cell Arteritis  (Rheumatology)

Clinical guidelines
Diagnosis and treatment of headache .
Institute for Clinical Systems Improvement.  1998 Aug (revised 2007 Jan).  72 pages.  NGC:005845

Treatment of primary headache: chronic daily headache. Standards of care for headache diagnosis and treatment .
National Headache Foundation.  2004.  8 pages.  NGC:004143
 
Headache.
American College of Radiology.  1996 (revised 2006).  8 pages.  NGC:005120

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Keywords

temporal arteritis, Horton giant cell arteritis, Horton disease, Horton's disease, Horton's giant cell arteritis, giant cell aortic arteritis, giant cell aortitis, juvenile temporal arteritis, central nervous system vasculitis, CNS vasculitis, giant cell arteritis, systemic vasculitis, temporal arteries, GCA, cranial arteritis, granulomatous arteritis

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Contributor Information and Disclosures

Author

Anthony W Allen, MD, Chief, Interventional Radiology, Brooke Army Medical Center; Associate Professor of Radiology, Uniformed Services University of the Health Sciences
Anthony W Allen, MD is a member of the following medical societies: American College of Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Timothy Biega, MD, Staff Physician, Department of Radiology, Tripler Regional Medical Center
Disclosure: Nothing to disclose.

Manish K Varma, MD, Chief of Interventional Radiology, Department of Radiology, Tripler Army Medical Center
Manish K Varma, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Anthony Watkinson, MD, Professor of Interventional Radiology, The Peninsula Medical School; Consultant and Senior Lecturer, Department of Radiology, The Royal Devon and Exeter Hospital, UK
Anthony Watkinson, MD is a member of the following medical societies: Radiological Society of North America, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Douglas M Coldwell, MD, PhD,, Principal, Coldwell Associates. Interventional Radiologist, Jane Phillips Medical Center, Bartlesville, OK
Douglas M Coldwell, MD, PhD, is a member of the following medical societies: American Association for Cancer Research, American College of Radiology, American Heart Association, American Physical Society, American Roentgen Ray Society, Society of Cardiovascular and Interventional Radiology, Southwest Oncology Group, and Special Operations Medical Association
Disclosure: Sirtex, Inc. Consulting fee Speaking and teaching

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Kyung J Cho, MD, FACR, William Martel Professor of Radiology, Interventional Radiology Fellowship Director, University of Michigan Health System
Kyung J Cho, MD, FACR is a member of the following medical societies: American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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