Role of ultrasonography in the diagnosis of temporal arteritis

Ball, Elizabeth; Walsh, Stewart R.; Tang, Tjun Yip; Gohil, Rohit; Clarke, J

doi:10.1002/bjs.7252

Cited by 163 publications

(90 citation statements)

References 39 publications

(104 reference statements)

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“…Three meta-analyses have supported the role of ultrasound in the diagnosis of GCA. [16][17][18] The presence of bilateral ultrasound abnormalities (both temporal arteries involved) provides high specificity (100%) for the diagnosis of GCA, but its sensitivity was 43%. 17 Two of the meta-analyses reported concerns with the quality of the included studies 16,18 and the third did not assess the methodological quality of the included studies.…”

Section: Ultrasound and Other Forms Of Imaging Compared With The Tradmentioning

confidence: 99%

“…[16][17][18] The presence of bilateral ultrasound abnormalities (both temporal arteries involved) provides high specificity (100%) for the diagnosis of GCA, but its sensitivity was 43%. 17 Two of the meta-analyses reported concerns with the quality of the included studies 16,18 and the third did not assess the methodological quality of the included studies. 17 Currently, the use of ultrasound as a diagnostic tool for GCA is relatively limited, perhaps as a result of practical reasons relating to training to use ultrasound or equipment availability to facilitate rapid access and evaluation of patients with suspected GCA.…”

Section: Ultrasound and Other Forms Of Imaging Compared With The Tradmentioning

confidence: 99%

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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

Luqmani

Lee

Singh

et al. 2016

Health Technol Assess

366

404

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Background Giant cell arteritis (GCA) is a relatively common form of primary systemic vasculitis, which, if left untreated, can lead to permanent sight loss. We compared ultrasound as an alternative diagnostic test with temporal artery biopsy, which may be negative in 9–61% of true cases. Objective To compare the clinical effectiveness and cost-effectiveness of ultrasound with biopsy in diagnosing patients with suspected GCA. Design Prospective multicentre cohort study. Setting Secondary care. Participants A total of 381 patients referred with newly suspected GCA. Main outcome measures Sensitivity, specificity and cost-effectiveness of ultrasound compared with biopsy or ultrasound combined with biopsy for diagnosing GCA and interobserver reliability in interpreting scan or biopsy findings. Results We developed and implemented an ultrasound training programme for diagnosing suspected GCA. We recruited 430 patients with suspected GCA. We analysed 381 patients who underwent both ultrasound and biopsy within 10 days of starting treatment for suspected GCA and who attended a follow-up assessment (median age 71.1 years; 72% female). The sensitivity of biopsy was 39% [95% confidence interval (CI) 33% to 46%], which was significantly lower than previously reported and inferior to ultrasound (54%, 95% CI 48% to 60%); the specificity of biopsy (100%, 95% CI 97% to 100%) was superior to ultrasound (81%, 95% CI 73% to 88%). If we scanned all suspected patients and performed biopsies only on negative cases, sensitivity increased to 65% and specificity was maintained at 81%, reducing the need for biopsies by 43%. Strategies combining clinical judgement (clinician’s assessment at 2 weeks) with the tests showed sensitivity and specificity of 91% and 81%, respectively, for biopsy and 93% and 77%, respectively, for ultrasound; cost-effectiveness (incremental net monetary benefit) was £485 per patient in favour of ultrasound with both cost savings and a small health gain. Inter-rater analysis revealed moderate agreement among sonographers (intraclass correlation coefficient 0.61, 95% CI 0.48 to 0.75), similar to pathologists (0.62, 95% CI 0.49 to 0.76). Limitations There is no independent gold standard diagnosis for GCA. The reference diagnosis used to determine accuracy was based on classification criteria for GCA that include clinical features at presentation and biopsy results. Conclusion We have demonstrated the feasibility of providing training in ultrasound for the diagnosis of GCA. Our results indicate better sensitivity but poorer specificity of ultrasound compared with biopsy and suggest some scope for reducing the role of biopsy. The moderate interobserver agreement for both ultrasound and biopsy indicates scope for improving assessment and reporting of test results and challenges the assumption that a positive biopsy always represents GCA. Future work Further research should address the issue of an independent reference diagnosis, standards for interpreting and reporting test results and the evaluation of ultrasound training, and should also explore the acceptability of these new diagnostic strategies in GCA. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Ultrasound and Other Forms Of Imaging Compared With The Tradmentioning

confidence: 99%

Section: Ultrasound and Other Forms Of Imaging Compared With The Tradmentioning

confidence: 99%

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

Luqmani

Lee

Singh

et al. 2016

Health Technol Assess

366

404

View full text Add to dashboard Cite

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“…It may present with vascular insufficiency and/or constitutional symptoms. Methods used in the evaluation of GCA are temporal artery biopsy, color duplex ultrasonography, angiography, MRI, scintigraphy, FDG-PET, and integrated FDG-PET/CT [8,18,19]. Temporal artery biopsy is still the gold standard for diagnosing GCA.…”

Section: Discussionmentioning

confidence: 99%

Fever of unknown origin: large vessel vasculitis diagnosed by PET/CT

et al. 2012

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PET/CT is starting to play an important role in evaluating fever of unknown origin (FUO), due to its ability to localize and delineate areas of high metabolic activity, such as neoplastic proliferation and inflammation, including vasculitis. We present a case of giant cell arteritis (GCA) in a 72 year old female patient admitted to our department with a four month history of FUO, weight loss and fatigue, without specific symptoms or signs. Laboratory investigations suggested acute phase response, with a pronounced erythrocyte sedimentation rate (ESR), high CRP level and microcytic anemia. A thorough diagnostic evaluation was performed in order to exclude an unknown primary tumor which was initially suspected due to a positive family history of cancer. Surprisingly, PET/CT revealed large vessel vasculitis affecting the ascending, descending and abdominal aorta, as well as subclavian, proximal brachial and carotid arteries bilaterally. Biopsy of the superficial temporal artery confirmed the diagnosis of GCA. Treatment with methylprednisolone and azathioprine led to resolution of clinical symptoms and normalization of laboratory parameters. In addition to the use of PET/CT in the evaluation of FUO, its value as a method complementary to temporal artery biopsy is also discussed.

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“…However most of the studies included in this meta-analysis were small, of modest quality and with a considerable degree of heterogeneity. Two further meta-analysis were published more recently in 2010 (Arida et al, 2010;Ball et al, 2010). In the first one, the sensitivity and specificity of the halo sign versus the ACRC as a reference standard were examined.…”

Section: Sensitivity and Specificity Of Cdus In Tamentioning

confidence: 99%

“…Compared with final diagnosis, sensitivity and specificity resulted of 68% and 91% for the presence of unilateral halo, and of 43% and 100% for bilateral halo, respectively. In the second meta-analysis performed by Ball and coll., (Ball et al, 2010), all studies in english language published up to 2009 with a minimum of 5 patients and using TA biopsy and/or ACRC criteria as the reference standard were included. When the halo sign was compared with TA biopsy, the weighted sensitivity and specificity resulted 75% and 83% respectively.…”

Section: Sensitivity and Specificity Of Cdus In Tamentioning

confidence: 99%