Color duplex ultrasonography findings of temporal arteries in a case of giant cell arteritis: role in diagnosis and follow-up

Abstract

Giant cell arteritis (GCA) is a systemic autoimmune disease that affects medium- and large-sized arteries. The diagnostic gold standard is the temporal artery biopsy, but it has limited sensitivity and some difficulties in reproducibility. Color duplex ultrasonography is a noninvasive, reproducible, and inexpensive method for diagnosis of temporal arteries involvement (temporal arteritis [TA]) in GCA with high sensitivity and specificity. We present the ultrasound findings at baseline and during follow-up in a case of TA in a patient with GCA.

Keywords: GCA; color duplex ultrasonography; halo sign; temporal arteries; temporal arteritis.

Figure 1

(A) Before treatment: left temporal artery ultrasonography features before steroid therapy showed a hypoechogenic halo of the temporal artery >0.5 mm in thickness. (B) Before treatment: left temporal artery ultrasonography features before steroid therapy showed a hypoechogenic halo of the temporal artery in longitudinal (left) and transverse (right) view (B-mode ultrasound). Abbreviation: B-mode, brightness-mode.

Figure 2

Before treatment, left temporal artery color duplex ultrasonography features before steroid therapy showed a hypoechogenic halo of the temporal artery and the presence of turbulent flow; longitudinal (left) and transverse (right) view.

Figure 3

Posttreatment left temporal artery color duplex ultrasonography, transverse (left) and longitudinal (right) view, showed disappearance of hypoechogenic halo of the temporal artery and of turbulent flow; longitudinal and transverse view, respectively.

Figure 4

(A) In the left side: before treatment, longitudinal view of right temporal artery CDU features before steroid therapy showed a hypoechogenic halo of the temporal artery and the presence of turbulent flow and weak flow because of the presence of halo sign corresponding to edema of artery wall (measured ~9 mm superior edema wall’s thickness and 8.2 mm inferior edema wall’s thickness). (B) Posttreatment, longitudinal and transverse view, respectively, of right temporal artery CDU showed reduction of halo sign and turbulent flow and a stronger flow than before treatment that corresponds to a significant reduction of edema of artery wall (measured ~0.45 mm superior edema wall’s thickness and 0.3 mm inferior edema wall’s thickness). Abbreviation: CDU, color duplex ultrasonography.