Novel ultrasonographic Halo Score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia

Geest, Kornelis S M van der; Borg, Frances; Kayani, Abdul; Paap, Davy; Gondo, Prisca; Schmidt, Wolfgang A.; Luqmani, Raashid; Dasgupta, Bhaskar

doi:10.1136/annrheumdis-2019-216343

Cited by 86 publications

(93 citation statements)

References 22 publications

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“…There is evidence that larger and more extensive halos may be associated with more severe disease such as ocular ischaemia. 27 Our algorithm also allows precise identification of uncertainty (ie, 'GCA uncertain' and 'treat as GCA with AT and/or clinical re-evaluation') (online supplemental figure S3, S4). 'GCA uncertain' group requires AT such as PET-CT, TAB or investigations for other pathology while withholding GC for GCA.…”

Section: Discussionmentioning

confidence: 99%

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Probability-based algorithm using ultrasound and additional tests for suspected GCA in a fast-track clinic

et al. 2020

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ObjectivesClinical presentations of giant cell arteritis (GCA) are protean, and it is vital to make a secure diagnosis and exclude mimics for urgent referrals with suspected GCA. The main objective was to develop a joined-up, end-to-end, fast-track confirmatory/exclusionary, algorithmic process based on a probability score triage to drive subsequent investigations with ultrasound (US) and any appropriate additional tests as required.MethodsThe algorithm was initiated by stratifying patients to low-risk category (LRC), intermediate-risk category (IRC) and high-risk category (HRC). Retrospective data was extracted from case records. The Southend pretest probability score (PTPS) overall showed a median score of 9 and a 75th percentile score of 12. We, therefore, classified LRC as PTPS <9, IRC 9–12 and HRC >12. GCA diagnosis was made by a combination of clinical, US, and laboratory findings. The algorithm was assessed in all referrals seen in 2018–2019 to test the diagnostic performance of US overall and in individual categories.ResultsOf 354 referrals, 89 had GCA with cases categorised as LRC (151), IRC (137) and HRC (66). 250 had US, whereas 104 did not (score <7, and/or high probability of alternative diagnoses). In HRC, US showed sensitivity 94%, specificity 85%, accuracy 92% and GCA prevalence 80%. In LRC, US showed sensitivity undefined (0/0), specificity 98%, accuracy 98% and GCA prevalence 0%. In IRC, US showed sensitivity 100%, specificity 97%, accuracy 98% and GCA prevalence 26%. In the total population, US showed sensitivity 97%, specificity 97% and accuracy 97%. Prevalence of GCA overall was 25%.ConclusionsThe Southend PTPS successfully stratifies fast-track clinic referrals and excludes mimics. The algorithm interprets US in context, clarifies a diagnostic approach and identifies uncertainty, need for re-evaluation and alternative tests. Test performance of US is significantly enhanced with PTPS.

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Section: Discussionmentioning

confidence: 99%

“…26 The TA halo score was determined, as recently described. 27 In addition, a provisional AA halo score was determined.…”

Section: Clinical Criteriamentioning

confidence: 99%

Probability-based algorithm using ultrasound and additional tests for suspected GCA in a fast-track clinic

et al. 2020

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“…To our knowledge, this is the rst study speci cally designed to compare the diagnostic value of the three published quantitative scores for GCA diagnosis (3,4). According to our ndings, the modi ed Halo Score does not improve the diagnostic accuracy when compared to halo count and Southend Halo Score (Table 2).…”

Section: Discussionmentioning

confidence: 78%

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

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Martínez-Barrio

Serrano-Benavente

et al. 2020

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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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“…We will use the 18 MHz probe in this study which is compliant with EULAR recommendations of using a probe of frequency > 15 MHz. We recently developed a halo score grading the halo thickness in temporal and axillary arteries [39]. Ultrasound halo score correlates with the vascular inflammation in GCA and strongly associated with ocular ischemia in GCA [39].…”

Section: Discussionmentioning

confidence: 99%

“…However, variation in extent and severity of these findings on temporal and axillary artery US in GCA is observed [38]. We have recently developed an ultrasonographic halo score that correlates with arterial inflammation in GCA [39]. In the current study, will further investigate the novel halo score as a diagnostic, prognostic and disease monitoring tool for GCA.…”

Section: Introductionmentioning

confidence: 92%

Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA)

et al. 2020

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Background: Giant cell arteritis (GCA) is a common large vessel vasculitis of the elderly, often associated with sight loss. Glucocorticoids (GC remain the mainstay of treatment, although biologic treatments have been approved. Biomarkers predicting disease severity, relapse rates and damage are lacking in GCA. EULAR recommends ultrasound (US) as the first investigation for suspected GCA. The cardinal US finding, a non-compressible halo, is currently categorised as either negative or positive. However, the extent and severity of this finding may vary. In this study, we hypothesise whether the extent and severity of the halo sign [calculated as a single composite Halo score (HS)] of temporal and axillary arteries may be of diagnostic, prognostic and monitoring importance; whether baseline HS is linked to disease outcomes, relapses and damage; whether HS can stratify GCA patients for individual treatment needs; whether HS can function as an objective monitoring tool during follow up. Methods: This is a prospective, observational study. Suspected GCA Participants will be selected from the GCA FTC at the participating centres in the UK. Informed consent will be obtained, and patients managed as part of standard care. Patients with GCA will have HS (temporal and axillary arteries) measured at baseline and months 1,3,6 and 12 long with routine clinical assessments, blood sampling and patient-reported outcomes (EQ5D). Non-GCA patients will be discharged back to the referral team and will have a telephone interview in 6 months. We aim to recruit 272 suspected GCA referrals which should yield 68 patients (25% of referrals) with confirmed GCA. The recruitment will be completed in 1 year with an estimated total study period of 24 months. Discussion: The identification of prognostic factors in GCA is both timely and needed. A prognostic marker, such as the HS, could help to stratify GCA patients for an appropriate treatment regimen. Tocilizumab, an IL-6R blocking agent, switches off the acute phase response (C-Reactive Protein), making it difficult to measure the disease activity. Therefore, an independent HS, and changes in that score during treatment and follow-up, maybe a more objective measure of response compare to patient-reported symptoms and clinical assessment alone.

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Novel ultrasonographic Halo Score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia

Cited by 86 publications

References 22 publications

Probability-based algorithm using ultrasound and additional tests for suspected GCA in a fast-track clinic

Probability-based algorithm using ultrasound and additional tests for suspected GCA in a fast-track clinic

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

Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA)

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