Diagnostic performance and utility of very high-resolution ultrasonography in diagnosing giant cell arteritis of the temporal artery.

Johnny K M Sundholm,Taisto Sarkola,Tom Pettersson,Anders Paetau,Anders Albäck

doi:10.1093/rap/rkz018

Johnny K M Sundholm, Taisto Sarkola + Show 3 more

Open Access

https://doi.org/10.1093/rap/rkz018

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Abstract

ObjectiveVery-high resolution US (VHRU; 55 MHz) provides improved resolution and could provide non-invasive diagnostic information in GCA of the temporal artery. The objective of this study was to assess the diagnostic utility of VHRU-derived intima thickness (VHRU-IT) in comparison to high-resolution US halo-to-Doppler ratio (HRU-HDR) in patients referred for temporal artery biopsy. MethodsVHRU and HRU of the temporal artery were performed before a biopsy procedure in 78 prospectively recruited consecutive patients who had received glucocorticoid treatment for a median of 8 days (interquartile range 0–13 days) before imaging. Based on the final diagnosis and biopsy findings, the study population was divided into the following four groups: non GCA (n = 40); clinical GCA with no inflammation on biopsy (n = 15); clinical GCA with inflammation limited to adventitia (n = 9); and clinical GCA with transmural inflammation (TMI; n = 11).ResultsBoth VHRU and HRU were useful for identifying subjects with TMI, with VHRU outperforming HRU (area under curve: VHRU-IT 0.99, 95% CI 0.97, 1.00; HRU-HDR 0.74, 95% CI 0.52, 0.96; P=0.026). The diagnostic utility for diagnosing clinical GCA (negative biopsy) or inflammation limited to the adventitia was poor for both VHRU and HRU-HDR. From 5 days after initiation of glucocorticoid treatment, VHRU-IT was increased in eight of nine patients, whereas HRU-HDR was positive in three of seven patients. Both methods showed excellent inter-observer agreement (Cohen’s κ: VHRU-IT 0.873; HRU-HDR 0.811).ConclusionIn suspected GCA, VHRU allows non-invasive real-time imaging of TMI manifestations of the temporal artery wall. VHRU-derived intimal thickness measurement seems to be more sensitive than the halo sign and HRU-HDR in detecting TMI in patients with prolonged glucocorticoid treatment.

Highlights

GCA is the most common inflammatory vasculopathy in adults [1]
The diagnostic utility for diagnosing clinical GCA or inflammation limited to the adventitia was poor for both Very-high resolution US (VHRU) and highresolution US halo-to-Doppler ratio (HRU-halo-to-Doppler ratio (HDR))
In group 1, the patients with no GCA, who had no inflammation on histology and a GCA diagnosis considered unlikely by a rheumatologist (n 1⁄4 42), the final diagnoses were polymyalgia rheumatica (n 1⁄4 13), fever of unknown origin (n 1⁄4 6), non-arteritic anterior ischaemic optic neuropathy (n 1⁄4 6), bacterial infection (n 1⁄4 5), neurological diseases, malignancy (n 1⁄4 3) and other rheumatic diseases (SS, RA and granulomatosis with polyangiitis, n 1⁄4 3)

Summary

Introduction

GCA is the most common inflammatory vasculopathy in adults [1] It affects predominantly medium and large arteries and has a global incidence of 10/100 000, with a higher incidence in northern Europe [2, 3]. It is more common in women, and there is a 50% co-morbidity with polymyalgia rheumatica [4]

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