Giant cell arteritis of the occipital arteries--a prospective color coded duplex sonography study in 78 patients

Abstract

Context: Occipital headache and nuchal pain may indicate the involvement of the occipital arteries (OCCA) in temporal arteritis (TA). Recently high resolution color coded sonography (CCDS) has greatly improved the imaging of small lumen arteries.

Objective: The aim of the present study was the demonstration of TA, of the OCCA in comparison with the superficial temporal artery (STA) by means of CCDS in patients with nuchal and occipital pain suspected of suffering from TA.

Design: Prospective study of 78 patients comparing CCDS findings of the OCCA and of the STA with the clinical diagnosis and the biopsy results.

Results: 27 patients received the diagnosis TA; there were 51 other diagnoses. CCDS of the OCCA reached a sensitivity in diagnosis of 63 % and a specificity of 100 % and in histology of 65 % and 100% respectively. CCDS of the STA reached a diagnostic sensitivity of 78 % and a specificity of 94% and of a histological sensitivity of 77 % and specificity of 82 %. Reversibility of CCDS abnormalities was monitored in 5 patients over a period of 13 to 42 days.

Conclusions: Involvement of the OCCA in TA patients is a frequent finding and may be the only pathological phenomenon in some patients with nuchal pain, occipital headache and occipital scalp tenderness. CCDS of the STA and OCCA contributed to the diagnosis of TA with a high rate of perivascular hypoechogenic abnormalities (stenoses and occlusions) and a low rate of these abnormalities in the control patients. However, CCDS cannot differentiate between inflammatory and degenerative artery disease and has limitations concerning spatial resolution. Before CCDS may replace biopsy in clinical practice the accuracy of the criteria recommended above should be tested in larger groups of patients.