The Usefullness of Subclavian Artery Ultrasound Assessment in Giant Cell Arteritis Evaluation

Oshinsky, Charles; Bays, Alison M.; Sacksen, Ingeborg; Jernberg, Elizabeth Torrey; Zierler, R. Eugene; Pollock, P. Scott

doi:10.1097/rhu.0000000000001909

Cited by 5 publications

(1 citation statement)

References 16 publications

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“…Protocols may additionally include the extracranial carotid arteries , vertebral arteries and subclavian arteries . Although subclavian arteries do not contribute to increased sensitivity, 50 the addition of vertebral arteries to the protocol enhances detection of extracranial vasculitis. 49 According to the author’s experience, patients with cranial GCA and exclusive vertebral involvement more frequently exhibit the cranial phenotype of GCA.…”

Section: How Extensively Should Ultrasound Be Performed?mentioning

confidence: 99%

Diagnosing vasculitis with ultrasound: findings and pitfalls

Schmidt,

Schäfer

2024

Therapeutic Advances in Musculoskeletal

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Rheumatologists are increasingly utilizing ultrasound for suspected giant cell arteritis (GCA) or Takayasu arteritis (TAK). This enables direct confirmation of a suspected diagnosis within the examination room without further referrals. Rheumatologists can ask additional questions and explain findings to their patients while performing ultrasound, preferably in fast-track clinics to prevent vision loss. Vascular ultrasound for suspected vasculitis was recently integrated into rheumatology training in Germany. New European Alliance of Associations for Rheumatology recommendations prioritize ultrasound as the first imaging tool for suspected GCA and recommend it as an imaging option for suspected TAK alongside magnetic resonance imaging, positron emission tomography and computed tomography. Ultrasound is integral to the new classification criteria for GCA and TAK. Diagnosis is based on consistent clinical and ultrasound findings. Inconclusive cases require histology or additional imaging tests. Robust evidence establishes high sensitivities and specificities for ultrasound. Reliability is good among experts. Ultrasound reveals a characteristic non-compressible ‘halo sign’ indicating intima-media thickening (IMT) and, in acute disease, artery wall oedema. Ultrasound can further identify stenoses, occlusions and aneurysms, and IMT can be measured. In suspected GCA, ultrasound should include at least the temporal and axillary arteries bilaterally. Nearly all other arteries are accessible except the descending thoracic aorta. TAK mostly involves the common carotid and subclavian arteries. Ultrasound detects subclinical GCA in over 20% of polymyalgia rheumatica (PMR) patients without GCA symptoms. Patients with silent GCA should be treated as GCA because they experience more relapses and require higher glucocorticoid doses than PMR patients without GCA. Scores based on intima-thickness (IMT) of temporal and axillary arteries aid follow-up of GCA, particularly in trials. The IMT decreases more rapidly in temporal than in axillary arteries. Ascending aorta ultrasound helps monitor patients with extracranial GCA for the development of aneurysms. Experienced sonologists can easily identify pitfalls, which will be addressed in this article.

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Section: How Extensively Should Ultrasound Be Performed?mentioning

confidence: 99%

Diagnosing vasculitis with ultrasound: findings and pitfalls

Schmidt,

Schäfer

2024

Therapeutic Advances in Musculoskeletal

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Imaging of giant cell arteritis – recent advances

Owen

Yates

Liew

et al. 2023

Best Practice & Research Clinical Rheumatology

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The value of axillary, facial, occipital, subclavian and common carotid arteries ultrasound in the diagnosis of giant cell arteritis

Martins-Martinho,

Bandeira,

James

et al. 2024

Rheumatology

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Objective To assess the diagnostic value for GCA in adding the axillary arteries (AX) to the temporal artery (TA) ultrasound, particularly in patients with a cranial phenotype of the disease; and to investigate the utility of facial (FA), occipital (OC), subclavian (SC) and common carotid (CC) ultrasound in patients with suspected GCA. Methods Patients with new-onset GCA and a positive ultrasound of the TA, AX, FA, OC, SC or CC, followed at the rheumatology departments of two academic centres, were retrospectively included. Results Two hundred and thirty patients were assessed. TA halo sign was identified in 206/230 (89.6%) cases, FA in 40/82 (48.8%), OC in 17/69 (24.6%), AX in 56/230 (24.3%), SC in 31/57 (54.4%) and CC in 14/68 (20.6%). Negative TA ultrasound was found in 24/230 (10.4%) patients: 22 had AX involvement, one exclusive OC involvement and one exclusive SC involvement. Adding AX evaluation to the TA ultrasound increased the diagnostic yield for GCA by 9.6%, whereas adding OC or SCs to the TA and AX ultrasound increased it by 1.4% and 1.8%, respectively. No value was found in adding the FA or CCs. Notably, 13 patients with cranial symptoms and four with exclusively cranial symptoms showed negative TA ultrasound but positive AX ultrasound. Conclusion Adding the evaluation of AXs to the TA ultrasound increased the number of patients diagnosed with GCA, even in cases of predominantly cranial symptoms. In the subset of patients where these arteries were assessed, no substantial benefit was found in adding the FA, OC, SC or CC arteries to the TA and AX ultrasonographic assessment.

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The Usefullness of Subclavian Artery Ultrasound Assessment in Giant Cell Arteritis Evaluation

Cited by 5 publications

References 16 publications

Diagnosing vasculitis with ultrasound: findings and pitfalls

Diagnosing vasculitis with ultrasound: findings and pitfalls

Imaging of giant cell arteritis – recent advances

The value of axillary, facial, occipital, subclavian and common carotid arteries ultrasound in the diagnosis of giant cell arteritis

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