Temporal Artery Compression Sign - A Novel Ultrasound Finding for the Diagnosis of Giant Cell Arteritis

Abstract

Purpose: In patients with suspected giant cell arteritis (GCA), a search for the perivascular halo sign, a sophisticated color duplex ultrasound (CDU) finding, at experienced centers reliably identifies inflamed temporal arteries (TA). We tested whether TA compression in patients with GCA, a simple, largely operator-independent maneuver, elicits contrasting echogenicity between the diseased artery wall and the surrounding tissue (compression sign). Materials and Methods: 80 individuals with suspected GCA were prospectively enrolled in this single-center study. In all study participants, bilateral ultrasound examination of the TA established the presence/absence of the halo and compression sign. A positive compression sign was defined as visibility of the TA upon transducer-imposed compression of the artery. Based on ACR criteria, a team of specialized physicians independently grouped patients as GCA versus non-GCA. Results: 43/80 study participants were grouped as GCA. Both the halo sign and the compression sign were positive in 34/43 patients in the GCA group, and negative in all 37/37 of the non-GCA group, resulting in a sensitivity of 79?% and a specificity of 100?% for both the halo and the compression sign. Conclusion: In this cohort of individuals with suspected GCA, the halo sign and the compression sign were equal in their diagnostic performance. The simplicity of the compression sign suggests a level of reliability warranting further evaluation.

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

“…We did not routinely employ a compression test to occlude the artery completely to eliminate flow; however, this is a useful test and was described to all sonographers to facilitate distinction between a true halo sign and a false one. 63 Each site sonographer was required to register the model number and manufacturer of his or her ultrasound machine with the TABUL office to ensure that it was of sufficiently high resolution for the purposes of the study; this was also reported for the subsequent economic analysis. If the sonographer changed the machine, he or she was required to inform the central TABUL office of the change, and the TABUL office had to confirm that the machine that had been substituted was of sufficiently high quality for the study.…”

Ultrasound imaging in the diagnosis of large vessel vasculitis

“…Most recently, Schmidt et al for the fi rst time established reference values for the temporal, facial, and axillary artery IMT in healthy elderly individuals (Table I) [5]. In 2013, Aschwanden et al reported their results using an adopted B-mode compression US protocol in the diagnosis of cranial GCA [6]. Applying slight pressure with the transducer until complete luminal occlusion, the arterial wall thickness (sum of near and far wall) of the superfi cial temporal arteries can be measured ( Figure 1).…”

“…As a result, diagnosis of cranial GCA with temporal artery CDUS more or less is based on the subjective impression of the investigator [6]. However, scarce data suggest substantial agreement between diff erent operators for detection of the temporal artery halo [3,21].…”

“…During the last decade, experienced centres reported sensitivities of 80-96 % and specifi cities of 90-100 %, respectively [6,27,28]. Similarly, compression US has been shown to be very sensitive (79 %) and highly specifi c (100 %) for the diagnosis of cranial GCA in a prospective single centre study ( Figure 1) [6].The bilateral halo sign has been shown to be 100 % specifi c for the diagnosis of cranial GCA (Figure 2) [26,27].…”

“…The transversal plane is much more informative as these vessels are commonly tortured in the elderly patient population and may run out of plane in the longitudinal section. In addition, we apply B-Mode compression sonography of the single temporal artery segments in order to accurately assess wall thickness [6]. Investigating other external carotid artery branches such as the facial or occipital arteries is not mandatory.…”