Comparison of temporal artery ultrasound versus biopsy in the diagnosis of giant cell arteritis

Hansen, Michael Stormly; Terslev, Lene; Jensen, Mads Radmer; Brittain, Jane Maestri; Døhn, Uffe Møller; Faber, Carsten; Heegaard, Steffen; Klefter, Oliver Niels; Kønig, Elisabeth Bay; Subhi, Yousif; Wiencke, Anne Katrine; Hamann, Steffen

doi:10.1038/s41433-022-01947-1

Cited by 11 publications

(8 citation statements)

References 23 publications

(31 reference statements)

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“…In another study, pooled results reported the halo sign the sensitivity and specificity of hypoehoic halo compared with positive temporal artery biopsy were 68% and 81%, respectively. 44 In patients not receiving immunosuppressive therapy, the diagnostic accuracy of PET in detecting large-vessel involvement was significantly higher (93.3 vs 64.5%). 55…”

Section: Color Duplex Sonographymentioning

confidence: 93%

“…This sign has variable size ranging from .7 to 2 mm and is specific for the diagnosis of GCA. [41][42][43][44] The lack of halo sign can basically exclude the diagnosis of GCA and lead to a reduction of an unnecessary biopsy performance. 45 Color duplex sonography is an inexpensive, non-invasive, and easy-to-perform method, allows a directional biopsy that has an increased probability to confirm the clinical diagnosis.…”

Section: Color Duplex Sonographymentioning

confidence: 99%

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Giant Cell Arteritis: Focusing on Current Aspects From the Clinic to Diagnosis and Treatment

et al. 2022

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Giant cell arteritis (GCA) is a granulomatous arteritis involving large arteries, particularly the aorta and its major proximal branches, including the carotid and temporal arteries. GCA involves individuals over 50 years old. The etiopathogenesis of GCA may involve a genetic background triggered by unknown environmental factors (eg infections), the activation of dendritic cells as well as inflammatory and vascular remodeling. However, its pathogenetic mechanism still remains unclear, although progress has been made in recent years. In the past, inflammatory markers and arterial biopsy were considered as gold standard for the diagnosis of GCA. However, emerging imaging methods have been made more sensitive and specific for the diagnosis of GCA. Treatment includes biological and other modalities including interleukin-6 (IL-6) inhibitors.

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Section: Color Duplex Sonographymentioning

confidence: 93%

Section: Color Duplex Sonographymentioning

confidence: 99%

Giant Cell Arteritis: Focusing on Current Aspects From the Clinic to Diagnosis and Treatment

et al. 2022

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“…A diagnosis of either definite GCA or definite non-GCA were given by reviewing the results of symptoms, examination findings, medication, blood biochemical measurements, and diagnostic tests which could be a combination of vascular ultrasound, 18-fluorodeoxyglucose positron emission tomography, and/or TAB. Uncertain cases were discussed between specialists until consensus [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Is Erythrocyte Sedimentation Rate Necessary for the Initial Diagnosis of Giant Cell Arteritis?

Hansen

Klefter

Terslev

et al. 2023

Life

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Giant cell arteritis (GCA) is an ophthalmological emergency that can be difficult to diagnose and prompt treatment is vital. We investigated the sequential diagnostic value for patients with suspected GCA using three biochemical measures as they arrive to the clinician: first, platelet count, then C-reactive protein (CRP), and lastly, erythrocyte sedimentation rate (ESR). This retrospective cross-sectional study of consecutive patients with suspected GCA investigated platelet count, CRP, and ESR using diagnostic test accuracy statistics and odds ratios (ORs) in a sequential fashion. The diagnosis was established by experts at follow-up, considering clinical findings and tests including temporal artery biopsy. A total of 94 patients were included, of which 37 (40%) were diagnosed with GCA. Compared with those without GCA, patients with GCA had a higher platelet count (p < 0.001), CRP (p < 0.001), and ESR (p < 0.001). Platelet count demonstrated a low sensitivity (38%) and high specificity (88%); CRP, a high sensitivity (86%) and low specificity (56%); routine ESR, a high sensitivity (89%) and low specificity (47%); and age-adjusted ESR, a moderate sensitivity (65%) and moderate specificity (65%). Sequential analysis revealed that ESR did not provide additional value in evaluating risk of GCA. Initial biochemical evaluation can be based on platelet count and CRP, without waiting for ESR, which allows faster initial decision-making in GCA.

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“…The ultrasound false negative rate was 4 in 78 (5%). Therefore, the sensitivity of ultrasound is almost on par with that of biopsy, although the overall diagnostic accuracy of ultrasound was somewhat lower [8].…”

Section: Main Clinical Findingsmentioning

confidence: 97%

Clinical evidence and diagnosis of temporal arteritis: a concise systematic review

Liedtke¹,

Daher²,

Moura³

et al. 2023

MedNEXT

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Introduction: Temporal arteritis (TA), or giant cell arteritis, is a systemic autoimmune vasculitis that affects patients over 50 years of age. Temporal artery biopsy is considered the gold standard for diagnosis, although it has low sensitivity. It was shown that TA can lead to irreversible blindness in about 20% of untreated cases. Objective: A concise systematic review was carried out to contribute to the diagnosis and treatment of temporal arteritis, assessing whether a series of patients met the clinical and laboratory criteria for diagnosis, regardless of the biopsy result, as well as whether these results alter the management of these patients. Methods: The research was carried out from December 2022 to January 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, following the PRISMA rules for systematic review. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 140 articles were found, and a total of 32 articles were evaluated and 6 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 32 studies with a high risk of bias and 43 studies that did not meet GRADE. It was concluded that, regardless of the biopsy result, all patients should immediately start treatment with corticosteroids. Early diagnosis and treatment must be performed to avoid compromising the contralateral eye. In addition, it is necessary to perform other diagnostic imaging tools to increase the sensitivity and closure of the diagnosis of temporal arteritis.

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Comparison of temporal artery ultrasound versus biopsy in the diagnosis of giant cell arteritis

Cited by 11 publications

References 23 publications

Giant Cell Arteritis: Focusing on Current Aspects From the Clinic to Diagnosis and Treatment

Giant Cell Arteritis: Focusing on Current Aspects From the Clinic to Diagnosis and Treatment

Is Erythrocyte Sedimentation Rate Necessary for the Initial Diagnosis of Giant Cell Arteritis?

Clinical evidence and diagnosis of temporal arteritis: a concise systematic review

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