Diagnostic value of ultrasound halo count and Halo Score in giant cell arteritis: a retrospective study from routine care

Collada, J. Molina; Martínez-Barrio, Julia; Serrano-Benavente, Belén; Castrejón, Isabel; Motta, L. R. Caballero; Folguera, L. Trives; Álvaro‐Gracia, José María

doi:10.1136/annrheumdis-2020-218631

Cited by 10 publications

(3 citation statements)

References 5 publications

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“…In addition, the halo count and Southend Halo Score have recently been proposed to quantify the extent of vascular in ammation by US and correlate with systemic markers of in ammation and risk for ocular ischaemia(3). These novel score systems have also been validated in routine care and showed an excellent diagnostic accuracy for GCA diagnosis (10,11).…”

Section: Discussionmentioning

confidence: 99%

Subclavian arteries involvement in patients with giant cell arteritis: do we need a modified Halo Score?

Collada

Martínez-Barrio

Serrano-Benavente

et al. 2020

Preprint

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Objective: To assess whether adding the subclavian arteries examination into the ultrasound (US) Southend Halo Score, as proposed in the modified Halo Score, improves the diagnostic accuracy of giant cell arteritis (GCA) and its relationship with systemic inflammation.Methods: Retrospective observational study of patients referred to a GCA fast track pathway (FTP) over a 1-year period. Patients underwent US exam of temporal and large vessel (LV) (carotid, subclavian and axillary) arteries. The extent of inflammation was measured by the halo count, the Southend Halo Score and the modified Halo Score. The gold standard for GCA diagnosis was clinical confirmation after 6 months follow-up.Results: 64 patients were evaluated in the FTP, 17(26.5%) had GCA. Subclavian arteries involvement was present only in patients with GCA (29.4% versus 0%,p<0.001). Overall, the three scores showed excellent diagnostic accuracy for GCA (ROC AUC 0.906, 0.930 and 0.928, respectively) and moderate correlations with acute phase reactants (0.35-0.51, p<0.01). Only the modified Halo Score correlated with markers of inflammation in patients with LV involvement. Conclusions: The inclusion of subclavian arteries examination in the modified Halo Score does not improve the diagnostic accuracy of GCA. Nevertheless, it correlates better with markers of systemic inflammation in LV-GCA

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Section: Discussionmentioning

confidence: 99%

Subclavian arteries involvement in patients with giant cell arteritis: do we need a modified Halo Score?

Collada

Martínez-Barrio

Serrano-Benavente

et al. 2020

Preprint

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“…In addition, the scores correlate positively with likelihood of having a subsequent positive TAB and they appear to be unaffected by cumulative steroid dose over the first week of treatment ( 50 ). These scores have so far been validated in one inception cohort for diagnosis but research is ongoing to assess their utility in monitoring disease activity long-term ( 20 ).…”

Section: Development Of An Us Score In Gcamentioning

confidence: 99%

Evolution of ultrasound in giant cell arteritis

Kirby

Flood²,

Mullan³

et al. 2022

Front. Med.

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Ultrasound (US) is being increasingly used to diagnose Giant Cell Arteritis (GCA). The traditional diagnostic Gold Standard has been temporal artery biopsy (TAB), but this is expensive, invasive, has a false-negative rate as high as 60% and has little impact on clinical decision-making. A non-compressible halo with a thickened intima-media complex (IMC) is the sonographic hallmark of GCA. The superficial temporal arteries (STA) and axillary arteries (AA) are the most consistently inflamed arteries sonographically and imaging protocols for evaluating suspected GCA should include at least these two arterial territories. Studies evaluating temporal artery ultrasound (TAUS) have varied considerably in size and methodology with results showing wide discrepancies in sensitivity (9–100%), specificity (66–100%), positive predictive value (36–100%) and negative predictive value (33–100%). Bilateral halos increase sensitivity as does the incorporation of pre-test probability, while prior corticosteroid use decreases sensitivity. Quantifying sonographic vasculitis using Halo Counts and Halo Scores can predict disease extent/severity, risk of specific complications and likelihood of treatment response. Regression of the Halo sign has been observed from as little as 2 days to as late as 7 months after initiation of immunosuppressive treatment and occurs at different rates in STAs than AAs. US is more sensitive than TAB and has comparable sensitivity to MRI and PET/CT. It is time-efficient, cost-effective and allows for the implementation of fast-track GCA clinics which substantially mitigate the risk of irreversible blindness. Algorithms incorporating combinations of imaging modalities can achieve a 100% sensitivity and specificity for a diagnosis of GCA. US should be a standard first line investigation in routine clinical care of patients with suspected GCA with TAB reserved only for those having had a normal US in the context of a high pre-test probability.

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“…CDUS halo count (range from 0 to 8) refers to the total number of arterial branches (superficial, parietal, frontal temporal arteries, and axillary arteries) where a halo sign is found [ 23 ]. CDUS halo score (range from 0 to 48) is calculated by grading the maximum intima-media thickening (in millimeters) for each arterial branch (Table S2 and S3 , supplementary data) [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment and comparison of probability scores to predict giant cell arteritis

Sargi,

Ducharme-Benard,

Benard

et al. 2023

Clin Rheumatol

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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.

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Diagnostic value of ultrasound halo count and Halo Score in giant cell arteritis: a retrospective study from routine care

Cited by 10 publications

References 5 publications

Subclavian arteries involvement in patients with giant cell arteritis: do we need a modified Halo Score?

Subclavian arteries involvement in patients with giant cell arteritis: do we need a modified Halo Score?

Evolution of ultrasound in giant cell arteritis

Assessment and comparison of probability scores to predict giant cell arteritis

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