The use of ultrasound to assess giant cell arteritis: review of the current evidence and practical guide for the rheumatologist

Abstract

Colour duplex sonography (CDS) of temporal arteries and large vessels is an emerging diagnostic tool for GCA. CDS can detect wall oedema, known as a halo, throughout the length of the vessel and shows higher sensitivity compared with biopsy. Specificity reaches 100% in case of bilateral halos. A positive compression sign has been demonstrated to be a robust marker with excellent inter-observer agreement. The assessment of other large vessels, particularly the axillary arteries, is recognized to further increase the sensitivity and to reliably represent extra-cranial involvement in other areas. Nevertheless, CDS use is still not widespread in routine clinical practice and requires skilled sonographers. Moreover, its role in the follow-up of patients still needs to be defined. The aim of this review is to provide the current evidence and technical parameters to support the rheumatologist in the CDS evaluation of patients with suspected GCA.

A new era for giant cell arteritis

“…US of the axillary arteries as well as the temporal arteries increases sensitivity of the test [41,51]. Careful clinical evaluation and assessment of the pre-test probability of diagnosis of GCA are still required, because the halo sign can rarely be found in other forms of vasculitis [52]. Further study is also needed to better define the confounding effects of atherosclerosis on temporal and axillary wall thickness [53].…”

“…To address these challenges, in certain centres fast track pathways have been established, providing widely advertised, rapid access to specialist clinical assessment, diagnostic evaluation including vascular US or other diagnostic tests and immediate therapy. Such pathways have been shown to reduce sight loss and have led to significant cost savings due to reduction of inpatient care [41] and reduction in TAB rate [41,52]. In one fast track centre, sight loss was reduced from 37 to 9% [40], in another from 27 to 8% [55].…”

European Headache Federation recommendations for neurologists managing giant cell arteritis

“…Major advantages of CDUS are that it is non-invasive and can sample the majority of main arterial territories which can be affected such as the common superficial temporal artery, frontal and parietal branches as well as axillary, carotid, subclavian and vertebral arteries [45,46]. The Temporal Artery Biopsy vs Ultrasound in Diagnosis of Giant Cell Arteritis (TABUL) study, a crosssectional prospective study of 381 patients investigated for GCA, has given the most comprehensive analysis of use of CDUS in GCA [45]; with this evidence CDUS has allowed for a significant reduction in the requirement for temporal artery biopsy [47].…”

Giant Cell Arteritis Presenting as Pyrexia of Unknown Origin in Asians: 2 Case Reports.

“…10 Recent studies suggest the validity of color Doppler ultrasound (CDS) in diagnosing GCA. 11 A systematic review by Buttgereit (78-100%) of CDS. 12 advantage of being safe, well tolerated and allows examination of cranial or extracranial vessels.…”