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Orbital magnetic resonance imaging of giant cell arteritis with ocular manifestations: a systematic review and individual participant data meta-analysis

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Abstract

Objectives

We conducted a systematic review and individual participant data meta-analysis of publications reporting the ophthalmologic presentation, clinical exam, and orbital MRI findings in patients with giant cell arteritis and ocular manifestations.

Methods

PubMed and Cochrane databases were searched up to January 16, 2022. Publications reporting patient-level data on patients with ophthalmologic symptoms, imaged with orbital MRI, and diagnosed with biopsy-proven giant cell arteritis were included. Demographics, clinical symptoms, exam, lab, imaging, and outcomes data were extracted. The methodological quality and completeness of reporting of case reports were assessed.

Results

Thirty-two studies were included comprising 51 patients (females = 24; median age, 76 years). Vision loss (78%) and headache (45%) were commonly reported visual and cranial symptoms. Ophthalmologic presentation was unilateral (41%) or bilateral (59%). Fundus examination most commonly showed disc edema (64%) and pallor (49%). Average visual acuity was very poor (2.28 logMAR ± 2.18). Diagnoses included anterior (61%) and posterior (16%) ischemic optic neuropathy, central retinal artery occlusion (8%), and orbital infarction syndrome (2%). On MRI, enhancement of the optic nerve sheath (53%), intraconal fat (25%), and optic nerve/chiasm (14%) was most prevalent. Among patients with monocular visual symptoms, 38% showed pathologic enhancement in the asymptomatic orbit. Six of seven cases reported imaging resolution after treatment on follow-up MRIs.

Conclusions

Vision loss, pallid disc edema, and optic nerve sheath enhancement are the most common clinical, fundoscopic, and imaging findings reported in patients diagnosed with giant cell arteritis with ocular manifestations, respectively. MRI may detect subclinical inflammation and ischemia in the asymptomatic eye and may be an adjunct diagnostic tool.

Clinical relevance statement

Brain and orbital MRIs may have diagnostic and prognostic roles in patients with suspected giant cell arteritis who present with ophthalmic symptoms.

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Abbreviations

BB-MRI:

Black-blood MRI

GCA:

Giant cell arteritis

TAB:

Temporal artery biopsy

VA:

Visual acuity

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Acknowledgements

Morgan P. Burke, BS is acknowledged for help with retrieving articles.

Funding

This study has received funding from the American Heart Association Career Development Award 938082 (Jae W Song, MD, MS) and NIH/NEI K08EY029765 (Qi N Cui, MD, PhD).

Author information

Author notes

  1. Konstanze V. Guggenberger and Athanasios Pavlou contributed equally.

Authors and Affiliations

  1. Department of Radiology, University of Würzburg, Würzburg, Germany

    Konstanze V. Guggenberger & Thorsten A. Bley

  2. Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA

    Athanasios Pavlou & Jae W. Song

  3. Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Athanasios Pavlou

  4. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA

    Quy Cao

  5. Drexel University College of Medicine, Philadelphia, PA, USA

    Ishaan J. Bhatt

  6. Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA

    Qi N. Cui

  7. Department of Radiology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA

    Hugh D. Curtin

  8. Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France

    Julien Savatovsky

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  1. Konstanze V. Guggenberger
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Corresponding author

Correspondence to Jae W. Song.

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Guarantor

The scientific guarantor of this publication is Jae W. Song, MD, MS.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Julien Savatovsky, MD reports fees to prepare and give lectures by Canon, Novartis; Boards: Bayer, Biogen; Travel expenses: Bayer. Stocks: Chipiron and Guerbet.

Statistics and biometry

Quy Cao, PhD, kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was not required for this study because it is a literature-based systematic review.

Ethical approval

Institutional Review Board approval was not required because it is a literature-based systematic review of the literature.

Study subjects or cohorts overlap

Not applicable.

Methodology

Systematic Review and Individual Participant Data Meta-Analysis of the Literature. The PRIMSA guidelines were followed. This study was registered with PROSPER (Clinical trial registration no. CRD42021254494).

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Guggenberger, K.V., Pavlou, A., Cao, Q. et al. Orbital magnetic resonance imaging of giant cell arteritis with ocular manifestations: a systematic review and individual participant data meta-analysis. Eur Radiol 33, 7913–7922 (2023). https://doi.org/10.1007/s00330-023-09770-2

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