Correspondence to ‘Slope sign’: a feature of large vessel vasculitis?

Milchert, Marcin; Brzosko, Marek; Haaversen, Anne Bull; Diamantopoulos, Andreas P.

doi:10.1136/annrheumdis-2019-216601

Cited by 7 publications

(6 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We agree with Milchert et al 1 that, in LV-GCA the slope is usually long. However, we disagree that atherosclerosis can demonstrate a sharp or short slope.…”

supporting

confidence: 94%

See 1 more Smart Citation

Response to: ‘Correspondence to ‘Slope sign’: a feature of large vessel vasculitis?’ by Milchert et al

2019

View full text Add to dashboard Cite

show abstract

“…We agree with Milchert et al 1 that, in LV-GCA the slope is usually long. However, we disagree that atherosclerosis can demonstrate a sharp or short slope.…”

supporting

confidence: 94%

“…We are grateful for the interest in our article and agree with Milchert et al 1 that the slope sign deserves a precise definition. Intimal medial thickness (IMT) of the axillary artery is the current way of assessing large vessel giant cell arteritis (LV-GCA) by ultrasound (US), with a cut-off value of greater than 1.0 mm suggesting LV-GCA 2.…”

supporting

confidence: 86%

Response to: ‘Correspondence to ‘Slope sign’: a feature of large vessel vasculitis?’ by Milchert et al

2019

View full text Add to dashboard Cite

show abstract

“…In 214 patients referred to a fast-track GCA clinic, 81 were diagnosed with GCA, 23 of whom had axillary vasculitis. The slope sign was observed in all patients with AA vasculitis ( 15 , 16 ).…”

Section: Defining the Presence Of Vasculitis On Ultrasoundmentioning

confidence: 87%

Evolution of ultrasound in giant cell arteritis

Kirby

Flood²,

Mullan³

et al. 2022

Front. Med.

View full text Add to dashboard Cite

Ultrasound (US) is being increasingly used to diagnose Giant Cell Arteritis (GCA). The traditional diagnostic Gold Standard has been temporal artery biopsy (TAB), but this is expensive, invasive, has a false-negative rate as high as 60% and has little impact on clinical decision-making. A non-compressible halo with a thickened intima-media complex (IMC) is the sonographic hallmark of GCA. The superficial temporal arteries (STA) and axillary arteries (AA) are the most consistently inflamed arteries sonographically and imaging protocols for evaluating suspected GCA should include at least these two arterial territories. Studies evaluating temporal artery ultrasound (TAUS) have varied considerably in size and methodology with results showing wide discrepancies in sensitivity (9–100%), specificity (66–100%), positive predictive value (36–100%) and negative predictive value (33–100%). Bilateral halos increase sensitivity as does the incorporation of pre-test probability, while prior corticosteroid use decreases sensitivity. Quantifying sonographic vasculitis using Halo Counts and Halo Scores can predict disease extent/severity, risk of specific complications and likelihood of treatment response. Regression of the Halo sign has been observed from as little as 2 days to as late as 7 months after initiation of immunosuppressive treatment and occurs at different rates in STAs than AAs. US is more sensitive than TAB and has comparable sensitivity to MRI and PET/CT. It is time-efficient, cost-effective and allows for the implementation of fast-track GCA clinics which substantially mitigate the risk of irreversible blindness. Algorithms incorporating combinations of imaging modalities can achieve a 100% sensitivity and specificity for a diagnosis of GCA. US should be a standard first line investigation in routine clinical care of patients with suspected GCA with TAB reserved only for those having had a normal US in the context of a high pre-test probability.

show abstract

“…However, vasculitis might co-exist with atherosclerosis in the same vessel. This sign was described for GCA but has yet to be validated in TAK [ 48 , 49 , 50 ].…”

Section: Angiographic and Imaging Outcomes In Takmentioning

confidence: 99%

Outcome Measures and Biomarkers for Disease Assessment in Takayasu Arteritis

et al. 2022

View full text Add to dashboard Cite

Takayasu arteritis (TAK) is a less common large vessel vasculitis where histopathology of involved arteries is difficult to access except during open surgical procedures. Assessment of disease activity in TAK, therefore, relies on surrogate measures. Clinical disease activity measures such as the National Institutes of Health (NIH) score, the Disease Extent Index in TAK (DEI.TAK) and the Indian TAK Clinical Activity Score (ITAS2010) inconsistently associate with acute phase reactants (APRs). Computerized tomographic angiography (CTA), magnetic resonance angiography (MRA), or color Doppler Ultrasound (CDUS) enables anatomical characterization of stenosis, dilatation, and vessel wall characteristics. Vascular wall uptake of 18-fluorodeoxyglucose or other ligands using positron emission tomography computerized tomography (PET-CT) helps assess metabolic activity, which reflects disease activity well in a subset of TAK with normal APRs. Angiographic scoring systems to quantitate the extent of vascular involvement in TAK have been developed recently. Erythrocyte sedimentation rate and C-reactive protein have a moderate performance in distinguishing active TAK. Numerous novel biomarkers are under evaluation in TAK. Limited literature suggests a better assessment of active disease by combining APRs, PET-CT, and circulating biomarkers. Validated damage indices and patient-reported outcome measures specific to TAK are lacking. Few biomarkers have been evaluated to reflect vascular damage in TAK and constitute important research agenda.

show abstract

Correspondence to ‘Slope sign’: a feature of large vessel vasculitis?

Cited by 7 publications

References 7 publications

Response to: ‘Correspondence to ‘Slope sign’: a feature of large vessel vasculitis?’ by Milchert et al

Response to: ‘Correspondence to ‘Slope sign’: a feature of large vessel vasculitis?’ by Milchert et al

Evolution of ultrasound in giant cell arteritis

Outcome Measures and Biomarkers for Disease Assessment in Takayasu Arteritis

Contact Info

Product

Resources

About