FRI0518 Ultrasound Definitions for Vasculitis in Cranial and Large Vessel Giant Cell Arteritis: Results of A Delphi Survey of The Omeract Ultrasound Large Vessel Vasculitis Group

Abstract

BackgroundIn a systematic literature review (SLR), we identified halo sign, stenosis, occlusion, compression sign and a decreased vessel wall pulsation as elementary ultrasound (US) lesions in giant cell arteritis (GCA).ObjectivesTo establish consensus-based definitions for the key elementary US lesions in GCA.MethodsWe invited 25 rheumatologists from 13 countries experienced in musculoskeletal and vascular US to participate in a Delphi exercise. Based on the results from the SLR and international expert consensus a questionnaire was developed including 12 statements on the definitions of normal temporal and extra-cranial large arteries, arteriosclerosis, halo sign, stenosis, occlusion, compression sign, and vessel wall pulsation. The experts were asked to express their level of agreement or disagreement with the proposed statements. A consensus was defined as agreement of ≥75% of participants.ResultsThe response rate was 24/25 (96%) in round 1 and 24/24 (100%) in round 2. A consensus was achieved for 9/9 Delphi statements [normal temporal and extra-cranial large arteries, arteriosclerosis, halo sign, stenosis of temporal and extra-cranial large arteries, occlusion, compression sign (temporal arteries), US assessment of compression sign (temporal arteries) in round 1. In round 2, 3/3 Delphi statements (arteriosclerosis, halo sign, stenosis of temporal arteries) were redefined. The statements on vessel wall pulsation (definition and assessment) and measurement of vessel wall thickness did not reach the threshold for consensus. The halo and compression signs were deemed to be the most important US signs for GCA with 100% and 83.3% expert agreement, respectively.ConclusionsThis is the first international consensus on definitions for elementary US lesions in GCA. The next steps of the OMERACT project will be web- and patients based exercises testing the reliability of the new definitions.Disclosure of InterestNone declared

Ultrasound Technologies and the Diagnosis of Giant Cell Arteritis

“…It is well outlined towards the luminal side both in longitudinal and transverse planes, most commonly concentric in tra It describes the edematous arterial wall swelling, whereas histology exam cell infiltrates and granulomas. TAB may miss the pathological zone because of mental appearance of temporal arteritis [30][31][32][33][34][35][36][37][38][39][40][41] (Figure 2) [11]. wave Doppler US is two or more times greater than the PSV recorded in the prestenotic segment of the vessel, with turbulence at the level of stenosis, associated with diminished velocities distal to the stenosis [30][31][32][33][34][35][36][37][38][39][40][41] (Figure 3) [11].…”

“…TAB may miss the pathological zone because of mental appearance of temporal arteritis [30][31][32][33][34][35][36][37][38][39][40][41] (Figure 2) [11]. wave Doppler US is two or more times greater than the PSV recorded in the prestenotic segment of the vessel, with turbulence at the level of stenosis, associated with diminished velocities distal to the stenosis [30][31][32][33][34][35][36][37][38][39][40][41] (Figure 3) [11]. ultrasound examiner; the wall swelling is hypoechogenic (in acute temporal arteritis), contrasting with the mid-echogenic to hyperechogenic surrounding tissue [38].…”

“…The advantages of US over different imaging techniques in GCA are described by its swiftness (approximately 15–20 min, if it’s executed by a skilled sonographer) and its high resolution (a high–frequency probe offers each an axial and a lateral resolution of 0.1 mm in B-mode) [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. In addition, US is more sensitive than TAB, because the later exams only have a limited anatomical location in systemic disease, like GCA.…”

“…Ultrasound exam observes that inflammation is often segmental, due to a discontinuous vessel damage-skip lesions in temporal arteries or other branches of ECAs [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ].…”

“…It describes the edematous arterial wall swelling, whereas histology exam displays cell infiltrates and granulomas. TAB may miss the pathological zone because of the segmental appearance of temporal arteritis [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] ( Figure 2 ) [ 11 ].…”