Impact of cardiovascular risk on the diagnostic accuracy of the ultrasound Halo Score for giant cell arteritis

Collada, J. Molina; Gloria, Katerine López; Castrejón, Isabel; Nieto‐González, Juan Carlos; Martínez-Barrio, Julia; Alfaro, A. M. Anzola; Rivera, Javier; Álvaro‐Gracia, José María

doi:10.1186/s13075-022-02920-9

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…Cut-off values for the thickness of the intima-media complex have been proposed for follow-up studies (common superficial temporal artery 0.42–0.44 mm, parietal branch 0.29–0.36 mm, frontal branch 0.34 mm, axillary artery 1.0 mm (0.9 mm for chronic vasculitis)) 55–58. They may also aid in distinguishing normal from acute or chronic vasculitis; however, further studies are required to validate these values, particularly in people with advanced age or with severe arteriosclerosis 59–61…”

Section: Resultsmentioning

confidence: 99%

EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update

Dejaco,

Ramiro,

Bond

et al. 2023

Ann Rheum Dis

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120

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ObjectivesTo update the EULAR recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV).MethodsA systematic literature review update was performed to retrieve new evidence on ultrasound, MRI, CT and [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis, monitoring and outcome prediction in LVV. The task force consisted of 24 physicians, health professionals and patients from 14 countries. The recommendations were updated based on evidence and expert opinion, iterating until voting indicated consensus. The level of agreement was determined by anonymous votes.ResultsThree overarching principles and eight recommendations were agreed. Compared to the 2018 version, ultrasound is now recommended as first-line imaging test in all patients with suspected giant cell arteritis, and axillary arteries should be included in the standard examination. As an alternative to ultrasound, cranial and extracranial arteries can be examined by FDG-PET or MRI. For Takayasu arteritis, MRI is the preferred imaging modality; FDG-PET, CT or ultrasound are alternatives. Although imaging is not routinely recommended for follow-up, ultrasound, FDG-PET or MRI may be used for assessing vessel abnormalities in LVV patients with suspected relapse, particularly when laboratory markers of inflammation are unreliable. MR-angiography, CT-angiography or ultrasound may be used for long-term monitoring of structural damage, particularly at sites of preceding vascular inflammation.ConclusionsThe 2023 EULAR recommendations provide up-to-date guidance for the role of imaging in the diagnosis and assessment of patients with LVV.

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Section: Resultsmentioning

confidence: 99%

EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update

Dejaco,

Ramiro,

Bond

et al. 2023

Ann Rheum Dis

Self Cite

120

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“…Prior studies have shown higher IMT levels in patients with atherosclerosis, with at least one TA segment above published cut-off values in approximately 10–20% of patients at high to very-high cardiovascular risk (CVR) (according to the European Society of Cardiology (ESC) 2021 classification) ( 25–28 ). Higher halo scores have also been described in non-GCA patients with high to very-high CVR ( 28 , 29 ). CVR is therefore expected to influence the diagnostic performance of IMT cut-off values, which is particularly relevant because high CVR is very prevalent in the age group of patients with GCA ( 28 , 30 ).…”

Section: Introductionmentioning

confidence: 85%

“…Higher halo scores have also been described in non-GCA patients with high to very-high CVR ( 28 , 29 ). CVR is therefore expected to influence the diagnostic performance of IMT cut-off values, which is particularly relevant because high CVR is very prevalent in the age group of patients with GCA ( 28 , 30 ).…”

Section: Introductionmentioning

confidence: 85%

Ultrasound intima-media thickness cut-off values for the diagnosis of giant cell arteritis using a dual clinical and MRI reference standard and cardiovascular risk stratification

Seitz,

Lötscher,

Bucher

et al. 2024

Front. Med.

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ObjectivesTo derive segmental cut-off values and measures of diagnostic accuracy for the intima-media thickness of compressed temporal artery segments for the diagnosis of giant cell arteritis (GCA) on the patient level. To examine the influence of cardiovascular risk.MethodsRetrospectively, patients evaluated for GCA with an ultrasound of the temporal arteries and an MRI of the head, including a T1-fatsat-black blood (T1-BB) sequence, were identified and classified based on cardiovascular risk and a dual reference standard of T1-BB on the segmental level and the clinical diagnosis on the patient level. Intima-media thickness of the common superficial temporal artery (CSTA), frontal and parietal branches (FB, PB) were measured by compression technique. Statistically and clinically optimal (specificity of approx. 90% for the patient level) cut-offs were derived. Diagnostic accuracy was evaluated on the patient level.ResultsThe population consisted of 144 patients, 74 (51.4%) with and 70 (48.6%) without GCA. The statistically optimal cut-offs were 0.86 mm, 0.68 mm and 0.67 mm for the CSTA, the FB and PB, respectively. On the patient level sensitivity and specificity were 86.5 and 81.4%. Clinically optimal cut-offs were 1.01 mm, 0.82 mm and 0.69 mm and showed a sensitivity of 79.7% and a specificity of 90.0%. For patients without high cardiovascular risk, statistically optimal cut-offs showed a sensitivity of 89.6% and a specificity of 90.5%.ConclusionNewly derived ultrasound intima-media thickness cut-offs with a dual reference standard show high diagnostic accuracy on the patient level for the diagnosis of GCA, particularly in patients without high cardiovascular risk.

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“…IMT may be slightly greater in patients with arteriosclerosis even when outside arteriosclerotic plaques. 98 , 104 …”

Section: Ultrasound For Disease Monitoringmentioning

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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Impact of cardiovascular risk on the diagnostic accuracy of the ultrasound Halo Score for giant cell arteritis

Cited by 8 publications

References 19 publications

EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update

EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update

Ultrasound intima-media thickness cut-off values for the diagnosis of giant cell arteritis using a dual clinical and MRI reference standard and cardiovascular risk stratification

Diagnosing vasculitis with ultrasound: findings and pitfalls

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