Session Information
Date: Sunday, November 17, 2024
Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster II
Session Type: Poster Session B
Session Time: 10:30AM-12:30PM
Background/Purpose: Vision loss associated with acute anterior ischemic optic neuropathy (AION) or central retinal artery occlusion (CRAO) can reveal giant cell arteritis (GCA). In this case, emergency initiation of high-dose glucocorticoids (GC) is needed to prevent blindness. However, 90% of AION and > 90% of CRAO are not caused by GCA and do not require GC treatment. These two entities remain challenging to distinguish. The aim of this study was to assess the performance of orbital MRI for differentiating between arteritic and non-arteritic AION and CRAO.
Methods: We conducted a prospective monocentric study enrolling patients aged > 50 years who were diagnosed with recent (< 14 days) AION or CRAO between June 2021 and December 2023 and who had no contraindications to MRI. The diagnosis of GCA was based on: 1) the judgment of the clinician, who had access to the usual tests (CRP, Doppler ultrasound, angio-CT or PET-CT, temporal artery biopsy, fluorescein angiography) but not to orbital MRI, and 2) the absence of any challenge to the diagnosis after 6 months of treatment. Orbital MRI was performed less than 72 hours after the onset of GC and interpreted by two radiologists blinded to the final diagnosis.
Results: Of the 25 patients enrolled, MRI imaging was analysable in 20 patients; 10 had arteritic involvement (3 bilateral) and 10 did not. Finally, we compared MRI findings between eyes with arteritic AION/CRAO (n=13) and eyes with non-arteritic AION/CRAO (n=10).
MRI showed enhancement of the ophthalmic artery wall in 76.9% of patients with GCA versus 30% of patients without GCA (p=0.04). Retrobulbar fat enhancement was observed in 92.3% of patients with GCA versus 10% of patients without GCA (p < 0.01). Periorbital fat and orbital muscle enhancement was observed in 84.6% and 38.5% of GCA cases versus 20% and 0% of non-GCA cases (p < 0.01 and p = 0.05, respectively).
We found no significant differences when comparing the “healthy” eyes of GCA and non-GCA patients.
Sensitivity (Se) and specificity (Sp) (95% confidence intervals) were 0.77 (0.50-0.92) and 0.70 (0.40-0.90) for ophthalmic artery enhancement, 0.84 (0.58-0.97) and 0.80 (0.49-0.96) for perineural fat enhancement, and 0.92 (0.67-0.99) and 0.90 (0.60-0.99) for retrobulbar fat enhancement.
Conclusion: Orbital MRI can show abnormalities associated with vasculitis of the orbital arteries, suggesting that it has promise as a diagnostic test for GCA in cases of AION or CRAO. This examination may allow clinicians to more rapidly identify GCA in patients with visual complications, especially when visual impairment is the only clinical manifestation and the inflammatory syndrome is moderate or absent.
To cite this abstract in AMA style:
BRENAC G, BERNARD A, GREIGERT H, LEMOGNE B, Ramon A, AUDIA S, LEGUY-SEGUIN V, RAZANAMAHERY J, ARNOULD L, CREUZOT-GARCHER C, Bonnotte B, SAMSON M. Orbital MRI as a Promising Approach for the Diagnosis of Giant Cell Arteritis in Case of Anterior Ischemic Optical Neuropathy or Central Retinal Artery Occlusion [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/orbital-mri-as-a-promising-approach-for-the-diagnosis-of-giant-cell-arteritis-in-case-of-anterior-ischemic-optical-neuropathy-or-central-retinal-artery-occlusion/. Accessed .« Back to ACR Convergence 2024
ACR Meeting Abstracts - https://acrabstracts.org/abstract/orbital-mri-as-a-promising-approach-for-the-diagnosis-of-giant-cell-arteritis-in-case-of-anterior-ischemic-optical-neuropathy-or-central-retinal-artery-occlusion/