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. 2025 Aug 1;64(8):4750-4755.
doi: 10.1093/rheumatology/keaf169.

Vascular MRI also depicts musculoskeletal manifestations in giant-cell arteritis-polymyalgia rheumatica spectrum disease patients

Daria Kern  1 , Thorsten A Bley  1 , Lukas Riedling  1 , Matthias Fröhlich  2 , Jost Hillenkamp  3 , Michael Gernert  2 , Marc Schmalzing  2 , Rudolf A Werner  4 , Konstanze V Guggenberger  1   5
Affiliations

Vascular MRI also depicts musculoskeletal manifestations in giant-cell arteritis-polymyalgia rheumatica spectrum disease patients

Daria Kern et al. Rheumatology (Oxford). .

Abstract

Objectives: To evaluate the incremental value of contrast-enhanced vascular MRI for also detecting inflammatory musculoskeletal manifestations in patients with GCA-PMR spectrum disease (GPSD).

Methods: T1-weighted contrast-enhanced volume interpolated breath-hold examination (VIBE)-sequences of the torso of 78 patients with clinically confirmed GPSD, acquired for vessel wall imaging of the aorta, were retrospectively evaluated for signs of inflammation in the glenohumeral synovium, long biceps and subscapularis tendons, supra-/interspinous ligaments, and for shoulder joint effusion. Two experienced radiologists and two inexperienced readers assessed the images independently. Inter-rater reliability between experienced and inexperienced readers was calculated.

Results: Forty-nine percent of the patients were diagnosed with GCA only, 28% with PMR only, and 23% with both GCA and PMR (GCA-PMR). Musculoskeletal inflammation was predominantly bilaterally symmetrical. Glenohumeral synovitis was found in 35% of all patients, shoulder joint effusion in 6%, long biceps tendon enhancement in 26%, subscapularis tendon enhancement in 42% and supra-/interspinous ligament enhancement in 29%. Patients with PMR showed inflammatory signs at a higher percentage compared with those with GCA or GCA-PMR. Fleiss's kappa indicated almost perfect agreement among readers for supra-/interspinous ligament and subscapularis tendon assessments.

Conclusions: Fifty-one percent of the GPSD patients showed signs of inflammation in at least one of the evaluated musculoskeletal structures on contrast-enhanced MRI, with the subscapularis tendon being the most frequently affected. A contrast-enhanced T1-weighted VIBE sequence provides a fast one-stop solution for assessing inflammatory wall changes of the aorta while simultaneously visualizing inflammation-suspect changes in the musculoskeletal structures of the torso within a reasonable examination time.

Keywords: giant cell arteritis; inflammation; magnetic resonance imaging; polymyalgia rheumatica.

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