Giant cell arteritis (GCA) (or Horton's disease) is a segmental and focal inflammatory arteritis affecting large and medium-sized arteries. Its incidence is estimated at 17.8/100,000 in subjects over 50 years old (and 46/100,000 in subjects over 70 years old). This disease remains a severe pathology due in particular to its vascular, ophthalmological, neurological, cardiac and aortic complications. In case of suspected CAG, management is a real therapeutic emergency. Indeed, only corticosteroid therapy started as early as possible can prevent the occurrence of these complications.
The gold standard for the diagnosis of CAG has long been the temporal artery biopsy, but imaging is now considered as a 1st line diagnostic examination for the diagnosis of CAG according to the EULAR 2018 recommendations. Notably, temporal artery MRI has excellent sensitivity and specificity for diagnosis.
However, the high diagnostic performance of MRI has been achieved by performing 3D T1 black blood and fat saturation sequences in high resolution (\<0.7mm), which are not accessible in all centers in France and worldwide.
The realization of identical sequences with a lower resolution could allow a greater generalization of these sequences and improve the diagnostic management of GCA patients, including in non-expert centers.
The objective of our study is to investigate the diagnostic performance of several 3D T1 black blood and fat saturation sequences for the diagnosis of GCA.
Patient over 18 years of age
Referred for imaging for an injected MRI for suspected GCA
Major criteria: Age > 50 years; Headache of recent onset; Claudication of the jaw, tongue or swallowing disorders; Visual problems (blindness, diplopia, blurred vision - including visual accidents occurring during the first week of treatment); Sedimentation rate at 1st hour > 50 and/or CRP > 8mg/l
Minor criteria: Hypersensitivity or induration of the scalp or presence of nodules remote from the temporal artery; Temporal artery abnormalities on palpation; Facial pain or feeling of facial edema; General signs (fever >38°C, weight loss >10%, anorexia, malaise, asthenia).
Newly diagnosed malignant disease (diagnosed less than one year prior to inclusion)
Active infectious disease
Autoimmune disease (especially but not limited to: Wegener's disease, Takayasu vasculitis, ANCA vasculitis, rheumatoid arthritis, lupus erythematosus, periarteritis nodosa).
Systemic corticosteroid therapy for more than 10 days at high dose (>0.5mg/kg/d of prednisone)
Participation in the study will be offered to all patients referred to imaging for an injected MRI for suspected GCA.
Cohort
Prospective
3D T1 MRI sequences injected with fat saturation and black blood
Diagnostic test3D T1 MRI sequences injected with fat saturation and black blood
Sensitivity of unilateral or bilateral inflammation of the temporal arteries and/or ophthalmic arteries or other branch of the internal carotid arteries with a 3D PDw MRI sequence for GCA diagnosis
The gold standard for the diagnosis of GCA will be based on a multidisciplinary evaluation (internists, neurologists, ophthalmologists) of the clinical and biological data in the patient's file at 3 months of inclusion, according to the criteria of the ACR (American College of Rheumatology) 2021, blinded to the MRI scans performed at inclusion. MRI imaging will be reviewed by two radiologists (one junior and one senior) to assess inflammation in each artery of interest. Consensus will be sought in the event of disagreement between the two readers.
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