Abstract
Early recognition of giant cell arteritis (GCA) is crucial to avoid the development of ischemic vascular complications, such as blindness. The classic approach to making the diagnosis of GCA is based on a positive temporal artery biopsy, which is among the criteria proposed by the American College of Rheumatology (ACR) in 1990 to classify a patient as having GCA. However, imaging techniques, particularly ultrasound (US) of the temporal arteries, are increasingly being considered as an alternative for the diagnosis of GCA. Recent recommendations from the European League Against Rheumatism (EULAR) for the use of imaging techniques for large vessel vasculitis (LVV) included US as the first imaging option for the diagnosis of GCA. Furthermore, although the ACR classification criteria are useful in identifying patients with the classic cranial pattern of GCA, they are often inadequate in identifying GCA patients who have the extracranial phenotype of LVV. In this sense, the advent of other imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET)/CT, has made it possible to detect the presence of extracranial involvement of the LVV in patients with GCA presenting as refractory rheumatic polymyalgia without cranial ischemic manifestations. Imaging techniques have been the key elements in redefining the diagnostic work-up of GCA. US is currently considered the main imaging modality to improve the early diagnosis of GCA.
Highlights
Giant cell arteritis (GCA), a condition that often overlaps with polymyalgia rheumatica, is the most common vasculitis among individuals who are over 50 years of age and of northern European ancestry [1,2]
CTA is another option for the diagnosis of extracranial large vessel vasculitis (LVV)-giant cell arteritis (GCA)
Diagnosis of GCA is crucial to improve outcomes for GCA patients and prevent irreversible vascular damage. In this sense, imaging tests have greatly advanced in the treatment of GCA in recent years
Summary
According to the last EULAR recommendations for the use of imaging in LVV [16], US of temporal arteries is recommended as the first imaging tool in patients with suspected predominantly cranial GCA. Ultrasound in patients with suspected cranial GCA should always include assessment of the temporal and axillary arteries, as stated in the EULAR imaging in LVV recommendations [16]. Ultrasound in patients with suspected cranial GCA should always include assessment of the temporal and axillary arteries, as stated in the EULAR imaging in LVV rec of 11 ommendations [16]. Temporal artery evaluations should include the common temporal arteries and their frontal and parietal branches, assessed both in longitudinal and transverse planes bilaterally Other arteries, such as facial, occipital, vertebral, subclavian and femoral arteries, can be examined when diagnosis of GCA is not clear. Given that carotid atherosclerosis is present in the majority of patients with suspected GCA, this group proposed a cut-off of temporal artery intima–media thickness > 0.34 mm in at least two branches to minimize false positives in the diagnosis of GCA [34]. In case the diagnosis of GCA is unclear, additional tests such as a temporal artery biopsy and/or other imaging techniques should be ordered
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