Colour Doppler ultrasound and the giant cell arteritis probability score for the diagnosis of giant cell arteritis: a Canadian single-centre experience

Zarka, Farah; Rhéaume, Maxime; Belhocine, M.; Goulet, M; Febrer, Guillaume; Mansour, Anne-Marie; Troyanov, Yves; Starnino, Tara; Meunier, Rosalie-Sélène; Chagnon, Isabelle; Routhier, Nathalie; Bénard, Valérie; Ducharme-Benard, Stéphanie; Ross, Carolyn; Makhzoum, Jean-Paul

doi:10.1093/rap/rkab083

Cited by 7 publications

(6 citation statements)

References 23 publications

(25 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The GCAPS was found to have the highest Se and lowest negative likelihood ratio (LR-). This is comparable to data previously published [ 11 , 14 ]. With a GCAPS < 9.5 points, clinicians may therefore feel comfortable in excluding a diagnosis of GCA.…”

Section: Discussionsupporting

confidence: 92%

“…Axillary arteries were scanned using the same technique. Performance and external validation of the CDUS equipment, technique, and ultrasound cut-off values for positivity had already been performed with results published [ 11 ]. Halo sign was defined as a hypoechoic circumferential intima-media complex, with a thickening of at least 0.4mm, 0.3mm, 0.3mm, and 1.0mm for the common superficial temporal artery, frontal temporal artery, parietal temporal artery, and axillary artery, respectively.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Assessment and comparison of probability scores to predict giant cell arteritis

Sargi,

Ducharme-Benard,

Benard

et al. 2023

Clin Rheumatol

Self Cite

View full text Add to dashboard Cite

Introduction/objectives To assess and compare the performance of the giant cell arteritis probability score (GCAPS), Ing score, Bhavsar-Khalidi score (BK score), color Doppler ultrasound (CDUS) halo count, and halo score, to predict a final diagnosis of giant cell arteritis (GCA). Method A prospective cohort study was conducted from April to December 2021. Patients with suspected new-onset GCA referred to our quaternary CDUS clinic were included. Data required to calculate each clinical and CDUS probability score was systematically collected at the initial visit. Final diagnosis of GCA was confirmed clinically 6 months after the initial visit, by two blinded vasculitis specialists. Diagnostic accuracy and receiver operator characteristic (ROC) curves for each clinical and CDUS prediction scores were assessed. Results Two hundred patients with suspected new-onset GCA were included: 58 with confirmed GCA and 142 without GCA. All patients with GCA satisfied the 2022 ACR/EULAR classification criteria. A total of 5/15 patients with GCA had a positive temporal artery biopsy. For clinical probability scores, the GCAPS showed the best sensitivity (Se, 0.983), whereas the BK score showed the best specificity (Sp, 0.711). As for CDUS, a halo count of 1 or more was found to have a Se of 0.966 and a Sp of 0.979. Combining concordant results of clinical and CDUS prediction scores showed excellent performance in predicting a final diagnosis of GCA. Conclusion Using a combination of clinical score and CDUS halo count provided an accurate GCA prediction method which should be used in the setting of GCA Fast-Track clinics. Key Points• In this prospective cohort of participants with suspected GCA, 3 clinical prediction tools and 2 ultrasound scores were compared head-to-head to predict a final diagnosis of GCA.• For clinical prediction tools, the giant cell arteritis probability score (GCAPS) had the highest sensitivity, whereas the Bhavsar-Khalidi score (BK score) had the highest specificity.• Ultrasound halo count was both sensitive and specific in predicting GCA.• Combination of a clinical prediction tool such as the GCAPS, with ultrasound halo count, provides an accurate method to predict GCA.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Assessment and comparison of probability scores to predict giant cell arteritis

Sargi,

Ducharme-Benard,

Benard

et al. 2023

Clin Rheumatol

Self Cite

View full text Add to dashboard Cite

show abstract

“…In five studies [35,38,43,45,48] including 1037 participants, the halo sign in temporal arteries was evaluated with the compression sign. This analysis yielded a pooled sensitivity value of 0.84 (95 CI 0.72-0.92; I 2 = 87.7%) and a pooled specificity of 0.95 (95 CI 0.88-0.98; I 2 = 86.3%) and the quality of evidence was moderate.…”

Section: The Compression Sign In Temporal Arteries In Gca Diagnosismentioning

confidence: 99%

Accuracy of Doppler ultrasound in the diagnosis of giant cell arteritis: a systematic review and meta-analysis

et al. 2023

View full text Add to dashboard Cite

Background Giant cell arteritis (GCA) is the most common primary systemic vasculitis in people 50 years of age and over, and it is considered a medical emergency due to the potential risk of permanent visual loss. Color Doppler ultrasound (CDU) of the temporal arteries is a rapid, noninvasive method to diagnose GCA. This study aims to determine the diagnostic accuracy of the halo sign in temporal arteries by CDU in people with suspected GCA. Methods The systematic literature review included the search for publications in the following electronic databases: PubMed, Embase, CENTRAL, LILACS, WHO ICTRP, ClinicalTrials.gov, gray literature up to December 2022, and no date or language restrictions were applied. We analyzed studies including patients over 50 years of age with suspected GCA evaluating CDU of temporal arteries as a diagnostic tool against clinical diagnosis as a standard reference. Paper titles and abstracts were selected by two investigators independently for all available records. The quality of the studies was assessed using the Quality of Diagnostic Accuracy Studies tool (QUADAS-2) and the R software (version 4.2.1) was used for data analysis. The protocol of this review is registered with PROSPERO (CRD42016033079). Results Twenty-two studies including 2893 participants with suspected GCA who underwent temporal artery CDU were evaluated. The primary analysis results showed a sensitivity of 0.76 [95% confidence interval (95 CI) 0.69–0.81] and specificity of 0.93 (95 CI 0.89–0.95) when the halo sign was compared to clinical diagnosis. The sensitivity value of 0.84 (95 CI 0.72–0.92) and specificity of 0.95 (95 CI 0.88–0.98) were found in five studies involving 1037 participants that analyzed the halo sign and temporal artery compression sign. A sensitivity of 0.86 (95 CI 0.78–0.91) and specificity of 0.95 (95 CI 0.89–0.98) were found in four studies with 603 participants where the halo sign was evaluated CDU on temporal and axillary arteries. Conclusion The detection of the halo sign by CDU of temporal arteries has good accuracy for the diagnosis of cranial GCA. The compression sign in temporal arteries and the addition of axillary arteries assessment improves the diagnostic performance of CDU for GCA. Trial registration PROSPERO CRD42016046860.

show abstract

“…For example, the European Alliance of Associations for Rheumatology recommends temporal artery duplex ultrasound as a first approach for establishing a diagnosis in patients with suspected GCA, but the American College of Rheumatology does not recommend temporal artery duplex ultrasound until a physician with specific expertise is available to oversee the procedure [ 4 , 5 ]. Our academic center has externally validated color doppler ultrasound in GCA and we have been using it as the first method of diagnosis of GCA since 2018 [ 6 ]. The patient in case 1 was seen in 2011 and the patient in case 3 was seen in 1995.…”

Section: Discussionmentioning

confidence: 99%

Rare Ischemic Complications of Giant Cell Arteritis: Case Series and Literature Review

2022

View full text Add to dashboard Cite

Case series Patients: Female, 75-year-old • Female, 76-year-old • Female, 72-year-old Final Diagnosis: Giant cell arteritis Symptoms: Ischemic complications of giant cell arteritis Medication: — Clinical Procedure: — Specialty: General and Internal Medicine • Rheumatology Objective: Challenging differential diagnosis Background: Some ischemic complications due to giant cell arteritis (GCA) are rare and underdiagnosed. We describe the clinical features and outcomes of patients with GCA presenting with rare ischemic complications. Case Reports: Our single-center retrospective database of patients with GCA was reviewed from 1994 to 2020. We describe 3 cases of rare ischemic complications secondary to GCA. We review the literature regarding ischemic complications due to GCA and their outcomes. All 3 cases met the American College of Rheumatology criteria for GCA. All patients experienced rare ischemic complications due to GCA. In case 1, the patient presented with a sixth cranial nerve palsy. In case 2, the patient presented with tongue and scalp necrosis, and with permanent visual loss due to anterior ischemic optic neuropathy. In case 3, the patient presented with scalp necrosis. In all 3 cases, the patients received glucocorticoids either intravenously and/or orally, which led to improvement. They all improved within the course of their followup visits. A literature review was performed to identify similar cases and outcomes. Conclusions: Ischemic complications due to GCA can be part of the initial presentation of the vasculitis, making confirmation of the diagnosis more difficult. Physicians should be aware of these rare complications since rapid diagnosis and initiation of glucocorticoids may alter the course of the disease.

show abstract

Colour Doppler ultrasound and the giant cell arteritis probability score for the diagnosis of giant cell arteritis: a Canadian single-centre experience

Cited by 7 publications

References 23 publications

Assessment and comparison of probability scores to predict giant cell arteritis

Assessment and comparison of probability scores to predict giant cell arteritis

Accuracy of Doppler ultrasound in the diagnosis of giant cell arteritis: a systematic review and meta-analysis

Rare Ischemic Complications of Giant Cell Arteritis: Case Series and Literature Review

Contact Info

Product

Resources

About