Journal article
Orbital magnetic resonance imaging of giant cell arteritis with ocular manifestations: a systematic review and individual participant data meta-analysis
European radiology, v 33(11), pp 7913-7922
01 Nov 2023
PMID: 37256352
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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.
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.
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.
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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Details
- Title
- Orbital magnetic resonance imaging of giant cell arteritis with ocular manifestations: a systematic review and individual participant data meta-analysis
- Creators
- Konstanze V Guggenberger - University of WürzburgAthanasios Pavlou - University of Maryland School of MedicineQuy Cao - University of PennsylvaniaIshaan J Bhatt - Drexel UniversityQi N Cui - University of PennsylvaniaThorsten A Bley - University of WürzburgHugh D Curtin - Harvard Medical SchoolJulien Savatovsky - Fondation Ophtalmologique Adolphe de RothschildJae W Song - University of Pennsylvania
- Publication Details
- European radiology, v 33(11), pp 7913-7922
- Grant note
- L30 EY029353 / NEI NIH HHS NEI/K08EY029765 / NEI NIH HHS 938082 / American Heart Association-American Stroke Association K08 EY029765 / NEI NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001000155200002
- Scopus ID
- 2-s2.0-85160779274
- Other Identifier
- 991022207072504721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Radiology, Nuclear Medicine & Medical Imaging