Cranial ultrasound for the diagnosis of giant cell arteritis. A retrospective cohort study

Abstract

Background: Establishing a diagnosis of giant cell arteritis, or indeed ruling it out, may be difficult. We describe an evaluation of temporal artery colour duplex ultrasound as first line investigation in patients with suspected giant cell arteritis. Methods: A retrospective cohort study of all patients undergoing colour duplex ultrasound for suspected giant cell arteritis between January 2005 and January 2014 was undertaken at a teaching hospital. A minimum clinical follow-up of three months was required. Patients were classified on the basis of ultrasound reports, using described features such as a halo sign or arterial wall thickening and clinical diagnosis of giant cell arteritis after at least 3 months follow-up, determined by the treating physician. The relationship of colour duplex ultrasound to a final clinical diagnosis of giant cell arteritis was analysed. Results: A total of 87 patients underwent colour duplex ultrasound: 36 (41%) had clinically confirmed giant cell arteritis at 3-month follow-up. The positive predictive value of colour duplex ultrasound for a clinical diagnosis at 3 months was 97% (95% confidence interval (CI) 93 to 99%) and negative predictive value 88% (95% CI 76 to 95%). Sensitivity was 81% (95% CI 64 to 92%) and specificity 98% (95% CI 90 to 100%). Conclusions: A high positive and negative predictive value of arteritis on colour duplex ultrasound indicates that temporal artery biopsy may be unnecessary in suspected giant cell arteritis, particularly where clinical suspicion of giant cell arteritis is high or low. Keywords 269clinical providers and archived paper medical records as necessary. For the purposes of this study, a clinical diagnosis of GCA made by a consultant rheumatologist, alone or in collaboration with other specialists, after a minimum of 3 months of follow-up, served as the reference or 'gold' standard for a diagnosis of GCA. The American College of Rheumatology (ACR) criteria for GCA were also used to classify all cases for comparison. 4 CDUS was performed on all patients. Examinations were performed by one of two consultant radiologists experienced in vascular ultrasound. Radiologists were not blinded to the suspicion of GCA or clinical data including laboratory test results. Studies were performed using a high-resolution multi-D linear array transducer VFX 13-5 MHz with a Doppler frequency above 6.5 MHz (Hitachi HA700, Hitachi Medical Systems). This probe gives a high frequency range up to 13 MHz and is designed for high resolution imaging of superficial structures. Each patient was examined using standard settings (frequencies of 13.0 MHz for B-mode and 9.0 MHz for colour-mode scanning).Ultrasound examination of the temporal arteries included longitudinal and transverse views of the common superficial temporal arteries and the frontal and parietal branches on both sides as completely as possible (dynamic range 45-50 dB, wall filter low or general, pulse repetition frequency 2250 Hz). The temporal and common carotid artery wall thicknesses on both s...

European Headache Federation recommendations for neurologists managing giant cell arteritis

“…The utility of TAB has been recommended by some international bodies to be superseded by non-invasive imaging modalities such as CDUS [20]. Some centres have chosen to use TAB when the results of CDUS are either equivocal or not in keeping with the clinical presentation [51].…”

A comparative study of Doppler ultrasound against temporal artery biopsy in the diagnosis of giant cell arteritis

“…In the following years, multiple studies were performed comparing ultrasound with biopsy or with GCA criteria, among which 2 meta-analyses stand out. 18,19,20,21,22 In the first of these, by Karassa et al, 23 studies (2036 patients) were analysed, with a sensitivity of 55% (36%-73%) with respect to meeting GCA criteria, and 69% (57%-79%) with respect to biopsy. 23 Specificity was 94% (82%-98%) and 82% (75%-87%), respectively.…”

Giant cell arteritis: reviewing the advancing diagnostics and management

“…Many clinicians scrutinise the value TAB and US as separate entities, however the paradigm of one-test-to-diagnose-them-all might be considered a myopic standpoint. Appreciation for the individual test's strengths and weaknesses, in combination with comprehensive history taking and examinations are fundamental in the work up of GCA [7,[106][107][108][109].…”