Contrast-enhanced T1-weighted 3D Black Blood Imaging and Its Value as Predictor for Temporal Arteritis in A Real World Setting

Giant-cell arteritis (GCA) of the superficial temporal artery presents diagnostic challenges due to its varied clinical manifestations and limitations of available laboratory markers. Imaging plays a crucial role in its diagnosis and monitoring. Contrast-enhanced T1-weighted 3D-Black Blood imaging (T1BB) offers promising potential in noninvasively assessing vascular changes associated with GCA. A retrospective, monocentric observational study involving 250 patients, including 14 with suspected GCA, was conducted using contrast-enhanced T1BB imaging alongside clinical, laboratory, histological and clinical data concerning their predictive value for diagnosing GCA. Inter-rater agreement and imaging accuracy were evaluated. The study revealed poor inter-rater agreement in detecting GCA-related changes using contrast-enhanced T1BB imaging. Sensitivity (10%) and positive predictive value (14%) were notably low, while specificity, negative predictive value, and accuracy were high (>90%). Histologically proven GCA cases often resulted in false negatives on MRI, specifically 9 out of 10 cases. While T1BB imaging demonstrated high specificity and negative predictive value, its low sensitivity and positive predictive value limit its use as a standalone diagnostic tool for GCA and complementary diagnostic methods may be necessary for accurate diagnosis and monitoring of GCA.