Role of the halo sign in the assessment of giant cell arteritis: a systematic review and meta-analysis

Abstract

Objectives This systematic review and meta-analysis aimed to evaluate the diagnostic value of the halo sign in the assessment of GCA. Methods A systematic literature review was performed using MEDLINE, EMBASE and Cochrane central register databases up to August 2020. Studies informing on the sensitivity and specificity of the US halo sign for GCA (index test) were selected. Studies with a minimum of five participants were included. Study articles using clinical criteria, imaging such as PET-CT and/or temporal artery biopsy (TAB) as the reference standards were selected. Meta-analysis was conducted with a bivariate model. Results The initial search yielded 4023 studies. Twenty-three studies (patients n = 2711) met the inclusion criteria. Prospective (11 studies) and retrospective (12 studies) studies in academic and non-academic centres were included. Using clinical diagnosis as the standard (18 studies) yielded a pooled sensitivity of 67% (95% CI: 51, 80) and a specificity of 95% (95% CI: 89, 98%). This gave a positive and negative likelihood ratio for the diagnosis of GCA of 14.2 (95% CI: 5.7, 35.5) and 0.375 (95% CI: 0.22, 0.54), respectively. Using TAB as the standard (15 studies) yielded a pooled sensitivity of 63% (95% CI: 50, 75) and a specificity of 90% (95% CI: 81, 95). Conclusion The US halo sign is a sensitive and specific approach for GCA assessment and plays a pivotal role in diagnosis of GCA in routine clinical practice. Registration PROSPERO 2020 CRD42020202179.

Evaluation of Arterial Histopathology and microRNA Expression That Underlie Ultrasonography Findings in Temporal Arteries of Patients with Giant Cell Arteritis

“…Characteristic US TA halo signs and the TA intima–media thickness showed a significant differentiation between the TAB-positive GCA patients and the TAB-negative GCA patients. Overall, our results regarding the US-measured TA vessel-wall thicknesses aligned well with the results of a large multicentric study entitled “The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis” (TABUL) [ 17 ], a recent meta-analysis [ 31 ], and a diagnostic performance utility study on the thickness of the intima–media complex [ 32 ]. In these studies, a cut-off value of intima–media thickness was determined at 0.4 mm for GCA diagnosis based on US measurement.…”

Clinical Images: Giant cell arteritis with positive temporal artery biopsy findings but without ultrasound halo sign

“…These changes were observed throughout the collected samples. A recent systematic review showed that, in the setting of GCA, the specificity of the appearance of halo sign on ultrasound is as high as 95% (95% confidence interval 89–98%) when the clinical diagnosis is used as a reference (1); however, this is especially true in the acute phase (2) and not in all phases (e.g., in the late phase as in the present case). Thus, in addition to ultrasound, a comprehensive examination, especially at the time of symptom onset, should be considered for the accurate diagnosis of GCA.…”

Point-of-Care Ultrasound in Neurology – Report of the EAN SPN/ESNCH/ERcNsono Neuro-POCUS Working Group

“…Local increase in blood flow velocities in the intracranial arteries and/or decreased pulsatility and/or resistance indices as a sign of migraine [79][80][81] Local increase in blood flow velocities in the intracranial arteries as a sign of reversible cerebral vasoconstriction syndrome, vasospasm [31,32] Arterial dissection [5,27,62] Local increase in blood flow velocities in the intracranial arteries and/or increased pulsatility and/or resistance indices as a sign of neuroinfection/vasculitis (meningitis, encephalitis) [9,14,24,59,77,78] Giant cell arteritis with halo sign [82] 4.…”