Background Temporal Arteritis (TA) is a common syndrome in the elderly, consisting of pain in the temporal area of the head, jaw claudication, sudden visual loss, high erythrocyte sedimentation rate and tenderness on palpation in the temporal area.

The diagnosis of this condition is relatively straightforward when the typical symptoms and positive temporal artery biopsy are present. Unfortunately, only one half of patients have positive temporal artery biopsy. Other diagnostic procedures such as colour Doppler sonography or superficial carotid arteriography have been proven to be useful for diagnosis of TA, but these techniques do not discriminate between inflammatory and noninflammatory temporal artery disease.¹ Genereau T. et al proposed that Gallium-67 (Ga67) planar scan may be useful in diagnosis of TA.²

Quantitative Ga67 Single Photon Emission Computed Tomography (SPECT) scintigraphy may rise the accuracy of TA diagnosis.

Objectives To assess the effectiveness and usefulness of Ga67 SPECT scintigraphy, two patients with suspected diagnosis of TA were examined. Quantitative estimation of Ga67 uptake was done.

Case 1: 61 years old male patient with biopsy proven TA relapsed after half a year period without prednisolone treatment. Clinical features were: severe headache in left temporal region, jaw claudication, fever and tenderness on palpation in left temporal area and high erythrocyte sedimentation rate.

Case 2: 79 years old female patient was admitted to the hospital with complaints on severe headache, night shoulder girdle pain and jaw claudication. Objective signs were tenderness on palpation in both temporal areas, limited active shoulder motion, high erythrocyte sedimentation rate. Because of a patient?s severe heart disease it was not possible to perform diagnostic temporal artery biopsy.

Both patients underwent Ga67 examination: a planar scan followed by a skull SPECT study. Ga67 uptake ratio was calculated (temporal region/background region) on transaxial and coronary slices after SPECT scan reconstruction.

Results In both cases the Ga67 planar scan was nondiagnostic for inflammatory process in the area. The SPECT study showed increased uptake in the temporal region, with high Ga67 uptake ratio.

Conclusion Our data suggests that Ga67 skull SPECT may be useful in the diagnosis of TA especially if Ga67 uptake ratio in the area is calculated. Further studies are needed to confirm these data.

References

1. Genereau T, Herson S. Les arterites temporales. Elements du diagnostic differentiel de la maladie de Horton [Temporal vasculitides. Differential diagnosis of giant cell arteritis]. Ann Med Intern (Paris) 1993;144:198–211

2. Genereau T, Lortholary O, Guillevin L, et al. Temporal 67 gallium uptake is increased in temporal arteritis. Rheumatology 1999;38:709–13