Involvement of the ophthalmic artery in giant cell arteritis visualized by 3T MRI

Objectives. To retrospectively analyse inflammatory involvement of the ophthalmic arteries in patients with GCA utilizing high-resolution MRI. Methods. A cohort of 50 patients with GCA who had been examined by 1.5 or 3T high-field MRI was analysed retrospectively in a consensus reading for possible involvement of the ophthalmic arteries. In 43 patients, entire orbits were within the field of view. In all cases, the superficial cranial arteries displayed mural inflammation in post-contrast T1-weighted spin-echo (SE) images. MRI results were compared with ophthalmological findings, subjective visual symptoms and laboratory values, i.e. CRP and ESR. Results. We observed mural contrast enhancement of the ophthalmic arteries in 20/43 patients (46%). Bilateral involvement was seen in 14, unilateral enhancement in six cases. Fifteen patients had ophthalmic vascular diseases: nine had anterior ischaemic optic neuropathy (AION), one posterior ischaemic optic neuropathy (PION), four revealed central retinal artery occlusion (CRAO) and one patient presented with narrowing of the retinal arteries. Funduscopy detected no arteritis-related changes in 22 cases. Of those patients who were MRI positive, seven had ophthalmological disease. Twenty-six patients complained of visual symptoms including amaurosis fugax, vision loss, diplopia or eye pain. Conclusions. High-resolution MRI detects mural contrast enhancement consistent with inflammatory changes in the superficial cranial and extracranial arteries and additionally in the ophthalmic arteries. This provides insight in vasculitic orbital involvement during one single investigation.