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

Abstract

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 12 weeks 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 2 weeks and in four patients at 4 weeks with a mean of disappearance of 21 days 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.

Color duplex ultrasonography findings of temporal arteries in a case of giant cell arteritis: role in diagnosis and follow-up

“…Salvarani et al reported that only halos >1 mm in thickness increased the probability of positive result of TA 20. On the contrary, Habib et al showed that smaller halos of ≥0.5 mm thickness can predict TA, a finding reported by others 7,21,22. In addition, bilateral halo sign yields a sensitivity of 37% and specificity of 100% in the diagnosis of TA, suggesting that the presence of bilateral halo sign in patients with clinically suspected TA can replace TAB in their final diagnosis, a suggestion reported by other studies 7,20.…”

Neuro-ophthalmology Annual Review

“…In one study, the presence of a halo sign on color Doppler ultrasound yielded 81% sensitivity and 88% specificity, whereas the presence of a bilateral halo sign was 37% sensitive and 100% specific. 113 In a 72-year-old woman with biopsy-proven GCA, Chaigne et al 114 reported CT and PET scan findings that showed aortic wall thickening and increased metabolic uptake without clinical involvement of the temporal arteries. Because PET does not image the temporal artery well, this type of imaging can be helpful for identifying larger vessel involvement in the unusual or atypical presentation of GCA.…”

Temporal Arteritis: Improving Patient Evaluation with a New Protocol

“…The most recent data show that the "halo sign" on duplex ultrasound image is highly specific for GCA (81% for unilateral halo and 100% for bilateral halo), and therefore biopsy adds nothing to the evaluation in these cases. 12,19 In fact, it would be difficult to imagine the justification not to treat a patient with an abnormal duplex ultrasound result, regardless of biopsy result, given biopsy's high falsenegative rate. With greater limitation of surgical resources, it becomes difficult to defend continuing to perform invasive procedures such as biopsy if the result will not influence the treatment decision.…”