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01-07-2021 | Giant Cell Arteritis | Magnetic Resonance

High-resolution MRI demonstrates signal abnormalities of the 3rd cranial nerve in giant cell arteritis patients with 3rd cranial nerve impairment

Authors: Sandy Mournet, Thomas Sené, Frédérique Charbonneau, Guillaume Poillon, Catherine Vignal, Gaëlle Clavel, Kévin Zuber, Julien Savatovsky, Augustin Lecler

Published in: European Radiology | Issue 7/2021

Abstract

Objective

To determine the sensitivity and specificity of high-resolution (HR) MRI for detecting signal abnormalities of cranial nerves (CN) in giant cell arteritis (GCA) patients presenting with diplopia.

Methods

This IRB-approved retrospective single-center study included GCA patients who underwent 3-T HR MRI from December 2014 to January 2020. Two radiologists, blinded to all data, individually assessed for the presence of enhancement of the 3rd, 4th, and/or 6th CN on post-contrast HR imaging and high signal intensity on HR T2-WI, for signal abnormalities of extraocular muscles and the brainstem, and for inflammatory changes of the ophthalmic and extracranial arteries. A Fisher’s exact test was used to compare patients with or without diplopia.

Results

In total, 64 patients (42/64 (66%) women and 22/64 (34%) men, mean age 76.3 ± 8 years) were included. Of the 64 patients, 14 (21.9%) presented with diplopia. Third CN enhancement was detected in 7/8 (87.5%) patients with 3rd CN impairment, as compared to no patients with 4th or 6th CN impairment or to patients without diplopia (p < 0.001). Third CN abnormal high signal intensity on HR T2-WI was detected in 4/5 patients (80%) with 3rd CN impairment versus none of other patients (p < 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value for detecting 3rd CN signal abnormalities were of 0.88, 1, 1, and 0.99 and 0.8, 1, 1, and 0.98 for post-contrast HR imaging and HR T2-WI, respectively.

Conclusions

HR MRI had excellent diagnostic sensitivity and specificity when detecting signal abnormalities of the 3rd CN in GCA patients presenting with 3rd CN impairment.

Key Points

• Third cranial nerve enhancement was detected in all patients with 3rd cranial nerve impairment except for one with transient diplopia.

• The “check mark sign” might be useful to identify 3rd cranial nerve signal abnormalities in the orbital apex.

• No signal abnormalities of the 4th or 6th cranial nerves could be detected on high-resolution MRI.

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Lie JT (2010) Illustrated histopathologic classification criteria for selected vasculitis syndromes. Arthritis Rheum 33:1074–1087. https://doi.org/10.1002/art.1780330804CrossRef

Salvarani C, Cantini F, Boiardi L, Hunder GG (2002) Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med 347:261–271. https://doi.org/10.1056/NEJMra011913CrossRefPubMed

Klink T, Geiger J, Both M et al (2014) Giant cell arteritis: diagnostic accuracy of MR imaging of superficial cranial arteries in initial diagnosis—results from a multicenter trial. Radiology 273:844–852. https://doi.org/10.1148/radiol.14140056CrossRefPubMed

Rhéaume M, Rebello R, Pagnoux C et al (2017) High-resolution magnetic resonance imaging of scalp arteries for the diagnosis of giant cell arteritis: results of a prospective cohort study. Arthritis Rheum 69:161–168. https://doi.org/10.1002/art.39824CrossRef

Bley TA, Wieben O, Vaith P et al (2004) Magnetic resonance imaging depicts mural inflammation of the temporal artery in giant cell arteritis. Arthritis Care Res 51:1062–1063. https://doi.org/10.1002/art.20840CrossRef

Poillon G, Collin A, Benhamou Y et al (2019) Increased diagnostic accuracy of giant cell arteritis using three-dimensional fat-saturated contrast-enhanced vessel-wall magnetic resonance imaging at 3 T. Eur Radiol. https://doi.org/10.1007/s00330-019-06536-7

Siemonsen S, Brekenfeld C, Holst B et al (2015) 3T MRI reveals extra- and intracranial involvement in giant cell arteritis. AJNR Am J Neuroradiol 36:91–97. https://doi.org/10.3174/ajnr.A4086CrossRefPubMedPubMedCentral

Remond P, Attyé A, Lecler A et al (2017) The central bright spot sign: a potential new MR imaging sign for the early diagnosis of anterior ischemic optic neuropathy due to giant cell arteritis. AJNR Am J Neuroradiol 38:1411–1415. https://doi.org/10.3174/ajnr.A5205CrossRefPubMedPubMedCentral

Bley TA, Markl M, Schelp M et al (2008) Mural inflammatory hyperenhancement in MRI of giant cell (temporal) arteritis resolves under corticosteroid treatment. Rheumatology (Oxford) 47:65–67. https://doi.org/10.1093/rheumatology/kem283CrossRef

10.

Bley TA, Uhl M, Carew J et al (2007) Diagnostic value of high-resolution MR imaging in giant cell arteritis. ANJR Am J Neuroradiol 28:1722–1727. https://doi.org/10.3174/ajnr.A0638CrossRefPubMed

11.

Dejaco C, Ramiro S, Duftner C et al (2018) EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 77:636–643. https://doi.org/10.1136/annrheumdis-2017-212649CrossRefPubMed

12.

Hellmich B, Agueda A, Monti S, et al (2019) 2018 update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 79(1):19–30. https://doi.org/10.1136/annrheumdis-2019-215672

13.

Vodopivec I, Rizzo JF (2018) Ophthalmic manifestations of giant cell arteritis. Rheumatology (Oxford) 57:ii63–ii72. https://doi.org/10.1093/rheumatology/kex428CrossRef

14.

Hayreh SS, Podhajsky PA, Zimmerman B (1998) Ocular manifestations of giant cell arteritis. Am J Ophthalmol 125:509–520. https://doi.org/10.1016/s0002-9394(99)80192-5CrossRefPubMed

15.

Ross A, Jivraj I, Rodriguez G et al (2019) Retrospective, multicenter comparison of the clinical presentation of patients presenting with diplopia from giant cell arteritis vs other causes. J Neuroophthalmol 39:8–13. https://doi.org/10.1097/WNO.0000000000000656CrossRefPubMed

16.

Mohammed-Brahim N, Clavel G, Charbonneau F et al (2019) Three Tesla 3D high-resolution vessel wall MRI of the orbit may differentiate arteritic from nonarteritic anterior ischemic optic neuropathy. Invest Radiol 54:712. https://doi.org/10.1097/RLI.0000000000000595CrossRefPubMed

17.

Sommer NN, Treitl KM, Coppenrath E et al (2018) Three-dimensional high-resolution black-blood magnetic resonance imaging for detection of arteritic anterior ischemic optic neuropathy in patients with giant cell arteritis. Invest Radiol 53:698–704. https://doi.org/10.1097/RLI.0000000000000500CrossRefPubMed

18.

Weisenburger-Lile D, Obadia M, Cahuzac A, Lecler A (2018) Ophthalmic artery MRI in an arteritis-related central retinal artery occlusion. Neurology 90:188–189. https://doi.org/10.1212/WNL.0000000000004864CrossRefPubMed

19.

Bossuyt PM, Reitsma JB, Bruns DE et al (2015) STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. Radiology 277:826–832. https://doi.org/10.1148/radiol.2015151516CrossRefPubMed

20.

Hunder GG, Bloch DA, Michel BA et al (1990) The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 33:1122–1128CrossRef

21.

Mandell DM, Mossa-Basha M, Qiao Y et al (2017) Intracranial vessel wall MRI: principles and expert consensus recommendations of the American Society of Neuroradiology. ANJR Am J Neuroradiol 38:218–229. https://doi.org/10.3174/ajnr.A4893CrossRefPubMed

22.

Tan HW, Chen X, Maingard J et al (2018) Intracranial vessel wall imaging with magnetic resonance imaging: current techniques and applications. World Neurosurg 112:186–198. https://doi.org/10.1016/j.wneu.2018.01.083CrossRefPubMed

23.

Lindenholz A, van der Kolk AG, Zwanenburg JJM, Hendrikse J (2018) The use and pitfalls of intracranial vessel wall imaging: how we do it. Radiology 286:12–28. https://doi.org/10.1148/radiol.2017162096CrossRefPubMed

24.

Ozanne A, Pereira V, Krings T et al (2008) Arterial vascularization of the cranial nerves. Neuroimaging Clin 18:431–439. https://doi.org/10.1016/j.nic.2007.12.010CrossRef

25.

Thurtell MJ, Longmuir RA (2014) Third nerve palsy as the initial manifestation of giant cell arteritis. J Neuroophthalmol 34:243–245. https://doi.org/10.1097/WNO.0000000000000116CrossRefPubMed

26.

Kim JH, Hwang J-M (2017) Imaging of cranial nerves III, IV, VI in congenital cranial dysinnervation disorders. Korean J Ophthalmol 31:183–193. https://doi.org/10.3341/kjo.2017.0024CrossRefPubMedPubMedCentral

27.

Ramkumar M, Sharma S, Jacob TG, Bhardwaj DN, Nag TC, Roy TS (2014) The human trochlear and abducens nerves at different ages - a morphometric study. Aging Dis 6:6–16. https://doi.org/10.14336/AD.2014.0310

Title: High-resolution MRI demonstrates signal abnormalities of the 3rd cranial nerve in giant cell arteritis patients with 3rd cranial nerve impairment
Authors: Sandy Mournet
Thomas Sené
Frédérique Charbonneau
Guillaume Poillon
Catherine Vignal
Gaëlle Clavel
Kévin Zuber
Julien Savatovsky
Augustin Lecler
Publication date: 01-07-2021
Publisher: Springer Berlin Heidelberg
Keywords: Giant Cell Arteritis
Giant Cell Arteritis
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Diplopia
Published in: European Radiology / Issue 7/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07595-x

2024 ASCO Annual Meeting

Springer Medicine

High-resolution MRI demonstrates signal abnormalities of the 3rd cranial nerve in giant cell arteritis patients with 3rd cranial nerve impairment

Abstract

Objective

Methods

Results

Conclusions

Key Points

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

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