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

• Published in: European radiology Vol. 33; no. 11; pp. 7913 - 7922
• Main Authors: Guggenberger, Konstanze V., Pavlou, Athanasios, Cao, Quy, Bhatt, Ishaan J., Cui, Qi N., Bley, Thorsten A., Curtin, Hugh D., Savatovsky, Julien, Song, Jae W.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2023; Springer Nature B.V
• Subjects: Acuity; Aged; Arteritis; Asymptomatic; Biopsy; Case reports; Cerebral blood flow; Data analysis; Demographics; Diagnostic Radiology; Edema; Edema - complications; Female; Giant Cell Arteritis - complications; Giant Cell Arteritis - diagnostic imaging; Head and Neck; Humans; Image resolution; Imaging; Internal Medicine; Interventional Radiology; Ischemia; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medical imaging; Medicine; Medicine & Public Health; Meta-analysis; Nerves; Neuroimaging; Neuroradiology; Occlusion; Optic chiasm; Optic nerve; Optic neuropathy; Optic Neuropathy, Ischemic - diagnosis; Optic Neuropathy, Ischemic - etiology; Orbital resonances (celestial mechanics); Patients; Radiology; Sheaths; Systematic review; Ultrasound; Vein & artery diseases; Vision; Vision Disorders; Visual acuity; Giant cell arteritis; Inflammation; Optic nerve; Magnetic resonance imaging; Orbit
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-09770-2

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.