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13.01.2021 | Magnetic Resonance

High-resolution MRI demonstrates signal abnormalities of the 3rd cranial nerve in giant cell arteritis patients with 3rd cranial nerve impairment

verfasst von: Sandy Mournet, Thomas Sené, Frédérique Charbonneau, Guillaume Poillon, Catherine Vignal, Gaëlle Clavel, Kévin Zuber, Julien Savatovsky, Augustin Lecler

Erschienen in: European Radiology | Ausgabe 7/2021

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Abstract

Objective

To determine the sensitivity and specificity of high-resolution (HR) MRI for detecting signal abnormalities of cranial nerves (CN) in giant cell arteritis (GCA) patients presenting with diplopia.

Methods

This IRB-approved retrospective single-center study included GCA patients who underwent 3-T HR MRI from December 2014 to January 2020. Two radiologists, blinded to all data, individually assessed for the presence of enhancement of the 3rd, 4th, and/or 6th CN on post-contrast HR imaging and high signal intensity on HR T2-WI, for signal abnormalities of extraocular muscles and the brainstem, and for inflammatory changes of the ophthalmic and extracranial arteries. A Fisher’s exact test was used to compare patients with or without diplopia.

Results

In total, 64 patients (42/64 (66%) women and 22/64 (34%) men, mean age 76.3 ± 8 years) were included. Of the 64 patients, 14 (21.9%) presented with diplopia. Third CN enhancement was detected in 7/8 (87.5%) patients with 3rd CN impairment, as compared to no patients with 4th or 6th CN impairment or to patients without diplopia (p < 0.001). Third CN abnormal high signal intensity on HR T2-WI was detected in 4/5 patients (80%) with 3rd CN impairment versus none of other patients (p < 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value for detecting 3rd CN signal abnormalities were of 0.88, 1, 1, and 0.99 and 0.8, 1, 1, and 0.98 for post-contrast HR imaging and HR T2-WI, respectively.

Conclusions

HR MRI had excellent diagnostic sensitivity and specificity when detecting signal abnormalities of the 3rd CN in GCA patients presenting with 3rd CN impairment.

Key Points

• Third cranial nerve enhancement was detected in all patients with 3rd cranial nerve impairment except for one with transient diplopia.

• The “check mark sign” might be useful to identify 3rd cranial nerve signal abnormalities in the orbital apex.

• No signal abnormalities of the 4th or 6th cranial nerves could be detected on high-resolution MRI.

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Titel: High-resolution MRI demonstrates signal abnormalities of the 3rd cranial nerve in giant cell arteritis patients with 3rd cranial nerve impairment
verfasst von: Sandy Mournet
Thomas Sené
Frédérique Charbonneau
Guillaume Poillon
Catherine Vignal
Gaëlle Clavel
Kévin Zuber
Julien Savatovsky
Augustin Lecler
Publikationsdatum: 13.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 7/2021
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07595-x

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High-resolution MRI demonstrates signal abnormalities of the 3rd cranial nerve in giant cell arteritis patients with 3rd cranial nerve impairment