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

Abstract

Objective. 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. Methods. 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. Results. 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%. Conclusion. 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.

Long-term inflammation in the temporal artery of a giant cell arteritis patient as detected by ultrasound

“…Dear Sir, Color Doppler ultrasonography (CDUS) is a sensitive, noninvasive technique, to diagnose vasculitis of the temporal artery and the large vessels [Diamantopoulos et al 2013]. In temporal arteritis, the halo sign (hypoechoic, dark area around the lumen of the temporal artery) seems to disappear within 2 days to 6 months after the start of treatment with corticosteroids [Santoro et al 2013;Schmidt, 2000;De Miguel et al 2012;Perez Lopez et al 2009].…”

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

“…11,115 Patients who had a positive biopsy but who did not have GCA were reported to have other forms of vasculitis. 59 We wanted to compare the performance of ultrasound, which we predicted would provide 87% sensitivity and 83% specificity or higher.…”

“…Imaging first emerged in the 1990s as a potential means by which to provide evidence to support a diagnosis of GCA. [8][9][10][11][12][13][14][15] High-resolution magnetic resonance imaging (MRI) of temporal arteries offers a non-invasive technique for investigating suspected GCA, but it is limited by availability and cost. Ultrasound is the most practical and widely used modality.…”

Systemic Vasculitis: Novelty in Classification, Diagnosis, and Treatment

“…Например, для выявления гиган- Р е д а к ц и о н н а я с т а т ь я токлеточного артериита, особенно поражений экстра-краниальных артерий, рекомендуется выполнение не только ультразвуковой доплерографии артерий (чувствительность метода -67 %, специфичность -95 %) [5], но и магнитно-резонансной томографии (чувствительность -78,4 %, специфичность -90,4 %) [6], позитронно-эмиссионной томографии [7] и ком-пьютерной томографической ангиографии [8]. Результаты последних исследований позволили описать клинические особенности течения гиган-токлеточного артериита [9].…”