{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T07:57:05Z","timestamp":1768723025543,"version":"3.49.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T00:00:00Z","timestamp":1717545600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T00:00:00Z","timestamp":1717545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Imaging"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>While early diagnosis of giant cell arteritis (GCA) based on clinical criteria and contrast-enhanced MRI findings can lead to early treatment and prevention of blindness and cerebrovascular accidents, previously reported diagnostic methods which utilize contrast-enhanced whole head images are cumbersome. Diagnostic delay is common as patients may not be aware of initial symptoms and their significance. To improve current diagnostic capabilities, new MRI-based diagnostic criteria need to be established. This study aimed to evaluate the \u201cmultifocal arcuate sign\u201d on short tau inversion recovery (STIR) and contrast-enhanced T1-weighted (CE-T1W) images as a novel extracranial finding for the diagnosis of GCA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 17 consecutive patients (including five with GCA) who underwent CE-T1W and whole-brain axial STIR imaging simultaneously between June 2010 and April 2020 were enrolled. We retrospectively reviewed their MR images. The \u201cmultifocal arcuate sign\u201d was defined as \u201cmultiple distant arcuate areas with high signal intensity in extracranial soft tissues such as subcutaneous fat, muscles, and tendons.\u201d Extracranial abnormal high-signal-intensity areas were classified as \u201cNone,\u201d when no lesions were detected; \u201cMonofocal,\u201d when lesions were detected only in one place; and \u201cMultifocal,\u201d when lesions were detected in multiple places. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of \u201cMultifocal\u201d areas were calculated using cross tabulation. Fisher\u2019s exact test was used to compare \u201cMultifocal\u201d areas in five patients with GCA and those with other diseases. In addition, mean Cohen\u2019s kappa and Fleiss\u2019 kappa statistics were used to compare inter-reader agreement.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The sensitivity, specificity, PPV, and NPV of the \u201cmultifocal arcuate sign\u201d in patients with GCA were 60%, 92\u2013100%, 75\u2013100%, and 85\u201386%, respectively. Significantly more patients with GCA had \u201cMultifocal\u201d areas compared to those with other diseases (Fisher\u2019s exact test, <jats:italic>p<\/jats:italic>\u2009=\u20090.008\u20130.027). Mean Cohen\u2019s kappa and Fleiss\u2019 kappa for inter-reader agreement with respect to the five GCA patients were 0.52 and 0.49, respectively, for both STIR and CE-T1W sequences.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The new radiologic finding of \u201cmultifocal arcuate sign\u201d on STIR and CE-T1W images may be used as a radiologic criterion for the diagnosis of GCA, which can make plain MRI a promising diagnostic modality.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12880-024-01314-4","type":"journal-article","created":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T11:54:18Z","timestamp":1717588458000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of the extracranial \u201cmultifocal arcuate sign,\u201d a novel MRI finding for the diagnosis of giant cell arteritis, on STIR and contrast-enhanced T1-weighted images"],"prefix":"10.1186","volume":"24","author":[{"given":"Toshitada","family":"Hiraka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiro","family":"Sugai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihiro","family":"Konno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuuki","family":"Toyoguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshie","family":"Obata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin","family":"Ohara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akiko","family":"Shibata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Takeda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Nishitsuka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunobu","family":"Ichikawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masafumi","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukihiko","family":"Sonoda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masafumi","family":"Kanoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,6,5]]},"reference":[{"key":"1314_CR1","doi-asserted-by":"publisher","first-page":"2442","DOI":"10.1001\/jama.2016.5444","volume":"315","author":"F Buttgereit","year":"2016","unstructured":"Buttgereit F, Dejaco C, Matteson EL, Dasgupta B. Polymyalgia Rheumatica and giant cell arteritis. JAMA. 2016;315:2442\u201358.","journal-title":"JAMA"},{"key":"1314_CR2","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1002\/art.24459","volume":"61","author":"MA Gonzalez-Gay","year":"2009","unstructured":"Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ, Miranda-Filloy JA, Gonzalez-Juanatey C, Martin J, et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum. 2009;61:1454\u201361.","journal-title":"Arthritis Rheum"},{"key":"1314_CR3","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1056\/NEJMcp1214825","volume":"371","author":"CM Weyand","year":"2014","unstructured":"Weyand CM, Goronzy JJ. Clinical practice: giant-cell arteritis and polymyalgia rheumatica. 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The need for Informed Consent was waived by the Ethical Review Committee of Yamagata University Faculty of Medicine because the study was pure observational.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"MR images and tables were anonymized and do not contain the personal information of patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"132"}}