An in-depth comparison of vascular inflammation on ultrasound, FDG-PET/CT and MRI in patients with suspected giant cell arteritis

BACKGROUND: Giant cell arteritis (GCA) is a difficult to diagnose large vessel vasculitis. CDUS, FDG-PET/CT and MRI are increasingly used for GCA diagnosis. This study aims to assess vascular wall lesions in GCA suspected patients, directly comparing CDUS, FDG-PET/CT and MRI with each other.

METHODS: In a nested-case control study, consecutive GCA suspected patients were included. Scans were retrospectively assessed by two experts per imaging modality. Inter- and intraobserver agreement using Cohen's or Fleiss Kappa were calculated to assess agreement between experts, a few duplicated scans and between imaging modalities. Sensitivity and specificity of the imaging modalities for overall diagnostic performance and for individual arteries were calculated.

RESULTS: In total, 42 patients were included. Overall diagnostic performance of imaging modalities was comparable. Sensitivity and specificity were highest in the temporal artery for CDUS (76% and 93%; Kappa > 0.7) and MRI (60% and 100%; Kappa > 0.7), and in the vertebral (61% and 100%; Kappa 0.56) and maxillary artery (52% and 100%; Kappa 0.75) for FDG-PET/CT. Agreement between all modalities for a positive temporal artery was 0.76, but only 0.28 between CDUS and FDG-PET/CT. Agreement for the axillary artery was 0.7 between CDUS and FDG-PET/CT.

CONCLUSION: The temporal artery can be assessed by CDUS and MRI with good sensitivity and high specificity, and the axillary artery by CDUS and FDG-PET/CT with high agreement between the two modalities. In addition, the vertebral and maxillary artery can be assessed by FDG-PET/CT with good sensitivity and specificity, however the vertebral artery had moderate interobserver agreement.