Temporal Artery Ultrasonography Research Articles

Halo sign on temporal artery ultrasound versus temporal artery biopsy for giant cell arteritis.

Halo sign on temporal artery ultrasound versus temporal artery biopsy for giant cell arteritis.

Sensitivity of temporal artery biopsy in the diagnosis of giant cell arteritis: a systematic literature review and meta-analysis.

Temporal artery biopsy (TAB) is a reference test for the diagnosis of GCA but reveals inflammatory changes only in a subset of patients. The lack of knowledge of TAB sensitivity hampers comparisons with non-invasive techniques such as temporal artery ultrasonography. We performed a systematic literature review and meta-analysis to estimate the sensitivity of TAB in GCA and to identify factors that may influence the estimate. A systematic literature review involved searching electronic databases and cross-references. Eligibility criteria included publications reporting at least 30 GCA cases fulfilling the original or modified 1990 ACR classification criteria. The pooled proportion of TAB-positive GCA cases was calculated by using aggregated-data meta-analysis with a random-effects model and assessment of heterogeneity with the I2 statistic. Subgroup analyses and meta-regression were used to examine the effect of patient and study characteristics on TAB positivity. Among 3820 publications screened, 32 studies (3092 patients) published during 1993-2017 were analysed. The pooled proportion of TAB-positive GCA cases was 77.3% (95% CI: 71.8, 81.9%), with high between-study heterogeneity (I2 = 90%). The proportion of TAB-positive cases was slightly higher in publications before than in 2012 and after (P = 0.001). The estimated sensitivity of 77% provides indirect evidence that TAB is not less sensitive than temporal artery imaging. The unexplained high between-study heterogeneity could result from differences in TAB sampling, processing or interpretation. The decrease in TAB-positive GCA cases over time could reflect an increasing propensity for clinicians to accept a GCA diagnosis without proof by TAB.

Giant cell arteritis: is the clinical spectrum of the disease changing?

BackgroundGiant cell arteritis is a vasculitis of large and middle-sized arteries that affects patients aged over 50 years. It can show a typical clinical picture consisting of cranial manifestations but sometimes nonspecific symptoms and large-vessel involvement prevail. Prompt diagnosis and treatment is essential to avoid irreversible damage.DiscussionThere has been an increasing knowledge on the occurrence of the disease without the typical cranial symptoms and its close relationship and overlap with polymyalgia rheumatica, and this may contribute to reduce the number of underdiagnosed patients. Although temporal artery biopsy is still the gold-standard and temporal artery ultrasonography is being widely used, newer imaging techniques (FDG-PET/TAC, MRI, CT) can be of valuable help to identify giant cell arteritis, in particular in those cases with a predominance of extracranial large-vessel manifestations.ConclusionsGiant cell arteritis is a more heterogeneous condition than previously thought. Awareness of all the potential clinical manifestations and judicious use of diagnostic tests may be an aid to avoid delayed detection and consequently ominous complications.

AB0565 Can Color Doppler Ultrasound BE Used to Monitor Treatment Response in Large Vessel GIANT Cell Arteritis?

BackgroundOn ultrasound examinations large vessel vasculitis (LVV) has been reported to be present in up to 37% of giant cell arteritis (GCA) patients. In these patients, the axillary arteries are...

FRI0445 Can Colour-Doppler Sonography of Temporal Arteries Replace Temporal Artery Biopsy in Patients Suspect of Having GIANT Cell Arteritis in Daily Clinical Practice?

BackgroundGiant cell arteritis (GCA) is the most common systemic vasculitis in patients over 50 years of age. Recently, the Colour-Doppler Sonography of temporal arteries (CDS-TA) has gained momentum as a...

Diagnostic Value of Color Doppler Ultrasonography of Temporal Arteries and Large Vessels in Giant Cell Arteritis: A Consecutive Case Series

Color Doppler ultrasonography (CDUS) can detect inflammation in the vessel wall. No studies have evaluated the examination of the common carotid artery by CDUS in the diagnostics of giant cell arteritis (GCA). Our aim was to evaluate the combination of CDUS examination of the temporal, axillary, and common carotid arteries in the diagnosis of GCA. Patients ages ≥50 years who were referred to our department between April 2010 and October 2012 and suspected to have GCA were consecutively examined. A positive clinical evaluation for GCA 6 months after the first evaluation by 3 rheumatologists was considered as the gold diagnostic standard. All patients underwent CDUS of the temporal, axillary, and common carotid arteries. A biopsy of the temporal artery was performed for most patients. A total of 88 patients were assessed. Forty-six patients were diagnosed to have GCA by the defined gold standard. Forty-eight patients had a positive CDUS of the temporal artery. Forty-six patients diagnosed with GCA had a positive CDUS of the temporal, common carotid, and axillary arteries (100% sensitivity) and 4 patients had a positive CDUS without having GCA (91% specificity). Among the 39 GCA patients that underwent a biopsy, vasculitis was observed in 26 patients (66%), yielding a sensitivity of 67% and a specificity of 95%. CDUS of the common carotid, axillary, and temporal arteries had an excellent sensitivity and high specificity to diagnose GCA. CDUS has the potential to replace biopsy in ordinary clinical care without compromising on sensitivity and specificity.

SAT0522 Value of the Doppler-Ultrasonography for the Diagnosis of Temporal Arteritis

BackgroundGiant cell arteritis (GCA) or Temporal Arteritis is the most common systemic vasculitis in adults. Usually, the diagnosis is based on the American College of Rheumatology (ACR) classification criteria published...

Color duplex ultrasonography of temporal arteries: role in diagnosis and follow-up of suspected cases of temporal arteritis

The objectives of this study are to study the diagnostic value of color duplex ultrasonography (CDU) compared with the clinical results and temporal artery biopsy (TAB) in patients with suspected temporal arteritis (TA) and evaluate the prognostic value of CDU in follow-up of patients of sure diagnosis of TA under treatment in correlation to clinical response. The study included 32 consecutive patients of clinically suspected TA, and 30 age- and gender-matched control subjects. Baseline clinical characteristics and bilateral CDU of temporal arteries were performed to all subjects. CDU aimed to assess presence of a dark halo around the arterial lumen (a halo sign) or presence of stenoses and occlusions of temporal arteries. Unilateral TAB was performed then in all patients but not in control subjects. Subsequent CDU examinations were performed at 2, 4, 8, and 12weeks after onset of treatment in patients with abnormal CDU. A halo sign at baseline CDU was evident in 13 TA patients (81%) and in 2 non-TA patients (12%) but none in control subjects. The presence of a halo sign in total yielded 81% sensitivity and 88% specificity whereas the presence of bilateral halo sign yielded 37% sensitivity and 100% specificity. Subsequent CDU examinations of TA patients showed disappearance of a halo sign in nine patients at 2weeks and in four patients at 4weeks with a mean of disappearance of 21days after initiation of treatment. CDU is non-invasive, easy, and inexpensive method for diagnosis of TA. It is of higher sensitivity and specificity. It can be used in combination with clinical and laboratory tools for diagnosis of TA. It can effectively predict which patient will need TAB. In patients with bilateral halo sign, TAB is not necessary.

Limited Value of Temporal Artery Ultrasonography Examinations for Diagnosis of Giant Cell Arteritis: Analysis of 77 Subjects

Use of TA-US for diagnostic investigation of giant cell arteritis (GCA) has been proposed but remains a matter of debate because of the heterogeneous findings. We retrospectively evaluated operating characteristics of temporal artery ultrasonography (TA-US) in a single teaching hospital. All subjects with suspected GCA had been seen between 2002 and 2008 and had undergone TA-US with continuous-wave Doppler (until 2004) or color duplex ultrasonography (after 2004), followed within 30 days by a temporal artery biopsy (TAB). TA-US findings were compared with TAB-proven GCA and clinically diagnosed GCA. Results are expressed as sensitivities, specificities, and positive (LR+) and negative likelihood ratios (LR-) of stenoses, occlusions, and the halo sign; for the latter, only color duplex TA-US was considered. Seventy-seven patients fulfilled the selection criteria; 13 had TAB-proven and 19 had clinically defined GCA. Stenoses/occlusions were seen on 45.5% of TA-US and the halo sign was seen only once (3.2%) in 31 duplex TA-US. Respective sensitivities, specificities, LR+, and LR- for GCA diagnosis (using TAB-proven/clinically defined GCA as reference standards) were 69%/53%, 59%/57%, 1.7/1.2, and 0.5/0.8 for stenoses and/or occlusions, and 17%/10%, 100%/100%, infinite/infinite, and 0.8/0.9 for the halo sign. The halo sign showed 100% specificity for GCA but only 10%-17% sensitivity. Stenoses/occlusions were of low diagnostic value. These observations suggest that TA-US is neither an effective substitute for TAB nor a reliable screening test to decide which patients can be safely spared TAB.

診断，治療効果の判定に側頭動脈エコー検査が有用であった側頭動脈炎症例の検討

診断，治療効果の判定に側頭動脈エコー検査が有用であった側頭動脈炎症例の検討

Meta-Analysis: Test Performance of Ultrasonography for Giant-Cell Arteritis

Giant-cell arteritis is a diagnostic challenge. To determine the diagnostic performance of ultrasonography for giant-cell arteritis. Studies published up to April 2004 in the MEDLINE, EMBASE, and Cochrane databases; reference lists; and direct contact with investigators. Studies in any language that examined temporal artery ultrasonography for diagnosis of giant-cell arteritis, enrolled at least 5 patients, and used biopsy or the American College of Rheumatology (ACR) criteria as the reference standard. Two reviewers independently graded methodologic quality and abstracted data on sensitivity and specificity of ultrasonography for giant-cell arteritis. Diagnostic performance was determined for the halo sign, stenosis, or occlusion and for any of these ultrasonographic abnormalities. Weighted sensitivity and specificity estimates and summary receiver-operating characteristic (ROC) curve analysis were used. Twenty-three studies, involving a total of 2036 patients, met the inclusion criteria. The weighted sensitivity and specificity of the halo sign were 69% (95% CI, 57% to 79%) and 82% (CI, 75% to 87%), respectively, compared with biopsy and 55% (CI, 36% to 73%) and 94% (CI, 82% to 98%), respectively, compared with ACR criteria. Stenosis or occlusion was an almost equally sensitive marker compared with either biopsy (sensitivity, 68% [CI, 49% to 82%]) or ACR criteria (sensitivity, 66% [CI, 32% to 89%]). Consideration of any vessel abnormality nonsignificantly improved diagnostic performance compared with ACR criteria. Between-study heterogeneity was significant, but summary ROC curves were consistent with weighted estimates. When the pretest probability of giant-cell arteritis is 10%, negative results on ultrasonography practically exclude the disease (post-test probability, 2% to 5% for various analyses). The primary studies were small and of modest quality and had considerable heterogeneity. Ultrasonography may be helpful in diagnosing giant-cell arteritis, but cautious interpretation of the test results based on clinical presentation and pretest probability of the disease is imperative.