Assessing Vasculitis in Giant Cell Arteritis by Ultrasound: Results of OMERACT Patient-based Reliability Exercises

Valentin S Schäfer^{1

2}, Stavros Chrysidis^{3

4}, Christian Dejaco^{3

4}, Christina Duftner^{3

4}, Annamaria Iagnocco^{3

4}, George A Bruyn^{3

4}, Greta Carrara^{3

4}, Maria Antonietta D'Agostino^{3

4}, Eugenio De Miguel^{3

4}, Andreas P Diamantopoulos^{3

4}, Ulrich Fredberg^{3

4}, Wolfgang Hartung^{3

4}, Alojzija Hocevar^{3

4}, Aaron Juche^{3

4}, Tanaz A Kermani^{3

4}, Matthew J Koster^{3

4}, Tove Lorenzen^{3

4}, Pierluigi Macchioni^{3

4}, Marcin Milchert^{3

4}, Uffe Møller Døhn^{3

4}, Chetan Mukhtyar^{3

4}, Cristina Ponte^{3

4}, Sofia Ramiro^{3

4}, Carlo A Scirè^{3

4}, Lene Terslev^{3

4}, Kenneth J Warrington^{3

4}, Bhaskar Dasgupta^{3

4}, Wolfgang A Schmidt^{3

4}

Affiliations

¹ From the University Hospital Bonn III, Medical Clinic, Department of Oncology, Hematology and Rheumatology, Bonn; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin; Asklepios Medical Center, Bad Abbach, Germany; Hospital of Southwest Denmark, Esbjerg; Diagnostic Centre Region Hospital Silkeborg, Silkeborg; Odense University Hospital, Odense; Copenhagen Center for Arthritis Research (COPECARE), Glostrup, Denmark; Medical University Graz, Graz; Medical University Innsbruck, Innsbruck, Austria; Hospital of Bruneck, Bruneck; Università degli Studi di Torino, Turin; Epidemiology Unit - Italian Society for Rheumatology (SIR), Milan; Arcispedale Santa Maria Nuova, Reggio Emilia; University of Ferrara, Italy; MC Groep Hospitals, Lelystad; Leiden University Medical Center, the Netherlands; Hôpital Ambroise Paré, Boulogne-Billancourt, France; University Hospital La Paz, Madrid, Spain; Martina Hansens Hospital, Bærum, Oslo, Norway; University Medical Centre Ljubljana, Ljubljana, Slovenia; University of California at Los Angeles, Los Angeles, California; Mayo Clinic, Rochester, Minnesota, USA; Pomeranian Medical University, Szczecin, Poland; Norfolk and Norwich University Hospital, Norwich; Southend University Hospital, UK National Health Service (NHS) Foundation Trust and Anglia Ruskin University, Westcliff, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Rheumatology Department, Hospital de Santa Maria - CHLN, Lisbon, Portugal. valentin.s.schaefer@hotmail.de.
² V.S. Schäfer, MD, University Hospital Bonn III, Medical Clinic, Department of Oncology, Hematology and Rheumatology, and Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Chrysidis, MD, Hospital of Southwest Denmark; C. Dejaco, MD, PhD, Medical University Graz, and Hospital of Bruneck; C. Duftner, MD, PhD, Medical University Innsbruck; A. Iagnocco, MD, Università degli Studi di Torino; G.A. Bruyn, MD, PhD, MC Groep Hospitals; G. Carrara, MSc, Epidemiology Unit - SIR; M.A. D'Agostino, MD, PhD, Hôpital Ambroise Paré; E. De Miguel, MD, University Hospital La Paz; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; U. Fredberg, MD, PhD, Diagnostic Centre Region Hospital Silkeborg, and Odense University Hospital; W. Hartung, MD, Asklepios Medical Center; A. Hocevar, MD, MSc, University Medical Centre Ljubljana; A. Juche, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; T.A. Kermani, MD, University of California at Los Angeles; M.J. Koster, MD, Mayo Clinic; T. Lorenzen, MD, Diagnostic Centre Region Hospital Silkeborg; P. Macchioni, MD, Arcispedale Santa Maria Nuova; M. Milchert, MD, PhD, Pomeranian Medical University; U.M. Døhn, MD, PhD, COPECARE; C. Mukhtyar, MBBS, MSc, MD, Norfolk and Norwich University Hospital; C. Ponte, MD, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, and Rheumatology Department, Hospital de Santa Maria - CHLN; S. Ramiro, MD, MSc, PhD, Leiden University Medical Center; C.A. Scirè, MD, PhD, Epidemiology Unit - SIR, and University of Ferrara; L. Terslev, MD, PhD, COPECARE; K.J. Warrington, MD, Mayo Clinic; B. Dasgupta, MBBS, MD, FRCP, Southend University Hospital, NHS Foundation Trust and Anglia Ruskin University; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch. valentin.s.schaefer@hotmail.de.
³ From the University Hospital Bonn III, Medical Clinic, Department of Oncology, Hematology and Rheumatology, Bonn; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin; Asklepios Medical Center, Bad Abbach, Germany; Hospital of Southwest Denmark, Esbjerg; Diagnostic Centre Region Hospital Silkeborg, Silkeborg; Odense University Hospital, Odense; Copenhagen Center for Arthritis Research (COPECARE), Glostrup, Denmark; Medical University Graz, Graz; Medical University Innsbruck, Innsbruck, Austria; Hospital of Bruneck, Bruneck; Università degli Studi di Torino, Turin; Epidemiology Unit - Italian Society for Rheumatology (SIR), Milan; Arcispedale Santa Maria Nuova, Reggio Emilia; University of Ferrara, Italy; MC Groep Hospitals, Lelystad; Leiden University Medical Center, the Netherlands; Hôpital Ambroise Paré, Boulogne-Billancourt, France; University Hospital La Paz, Madrid, Spain; Martina Hansens Hospital, Bærum, Oslo, Norway; University Medical Centre Ljubljana, Ljubljana, Slovenia; University of California at Los Angeles, Los Angeles, California; Mayo Clinic, Rochester, Minnesota, USA; Pomeranian Medical University, Szczecin, Poland; Norfolk and Norwich University Hospital, Norwich; Southend University Hospital, UK National Health Service (NHS) Foundation Trust and Anglia Ruskin University, Westcliff, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Rheumatology Department, Hospital de Santa Maria - CHLN, Lisbon, Portugal.
⁴ V.S. Schäfer, MD, University Hospital Bonn III, Medical Clinic, Department of Oncology, Hematology and Rheumatology, and Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Chrysidis, MD, Hospital of Southwest Denmark; C. Dejaco, MD, PhD, Medical University Graz, and Hospital of Bruneck; C. Duftner, MD, PhD, Medical University Innsbruck; A. Iagnocco, MD, Università degli Studi di Torino; G.A. Bruyn, MD, PhD, MC Groep Hospitals; G. Carrara, MSc, Epidemiology Unit - SIR; M.A. D'Agostino, MD, PhD, Hôpital Ambroise Paré; E. De Miguel, MD, University Hospital La Paz; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; U. Fredberg, MD, PhD, Diagnostic Centre Region Hospital Silkeborg, and Odense University Hospital; W. Hartung, MD, Asklepios Medical Center; A. Hocevar, MD, MSc, University Medical Centre Ljubljana; A. Juche, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; T.A. Kermani, MD, University of California at Los Angeles; M.J. Koster, MD, Mayo Clinic; T. Lorenzen, MD, Diagnostic Centre Region Hospital Silkeborg; P. Macchioni, MD, Arcispedale Santa Maria Nuova; M. Milchert, MD, PhD, Pomeranian Medical University; U.M. Døhn, MD, PhD, COPECARE; C. Mukhtyar, MBBS, MSc, MD, Norfolk and Norwich University Hospital; C. Ponte, MD, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, and Rheumatology Department, Hospital de Santa Maria - CHLN; S. Ramiro, MD, MSc, PhD, Leiden University Medical Center; C.A. Scirè, MD, PhD, Epidemiology Unit - SIR, and University of Ferrara; L. Terslev, MD, PhD, COPECARE; K.J. Warrington, MD, Mayo Clinic; B. Dasgupta, MBBS, MD, FRCP, Southend University Hospital, NHS Foundation Trust and Anglia Ruskin University; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch.

PMID: 29961687
DOI: 10.3899/jrheum.171428

Assessing Vasculitis in Giant Cell Arteritis by Ultrasound: Results of OMERACT Patient-based Reliability Exercises

Valentin S Schäfer et al. J Rheumatol. 2018 Aug.

. 2018 Aug;45(9):1289-1295.

doi: 10.3899/jrheum.171428. Epub 2018 Jul 1.

Authors

Affiliations

¹ From the University Hospital Bonn III, Medical Clinic, Department of Oncology, Hematology and Rheumatology, Bonn; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin; Asklepios Medical Center, Bad Abbach, Germany; Hospital of Southwest Denmark, Esbjerg; Diagnostic Centre Region Hospital Silkeborg, Silkeborg; Odense University Hospital, Odense; Copenhagen Center for Arthritis Research (COPECARE), Glostrup, Denmark; Medical University Graz, Graz; Medical University Innsbruck, Innsbruck, Austria; Hospital of Bruneck, Bruneck; Università degli Studi di Torino, Turin; Epidemiology Unit - Italian Society for Rheumatology (SIR), Milan; Arcispedale Santa Maria Nuova, Reggio Emilia; University of Ferrara, Italy; MC Groep Hospitals, Lelystad; Leiden University Medical Center, the Netherlands; Hôpital Ambroise Paré, Boulogne-Billancourt, France; University Hospital La Paz, Madrid, Spain; Martina Hansens Hospital, Bærum, Oslo, Norway; University Medical Centre Ljubljana, Ljubljana, Slovenia; University of California at Los Angeles, Los Angeles, California; Mayo Clinic, Rochester, Minnesota, USA; Pomeranian Medical University, Szczecin, Poland; Norfolk and Norwich University Hospital, Norwich; Southend University Hospital, UK National Health Service (NHS) Foundation Trust and Anglia Ruskin University, Westcliff, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Rheumatology Department, Hospital de Santa Maria - CHLN, Lisbon, Portugal. valentin.s.schaefer@hotmail.de.
² V.S. Schäfer, MD, University Hospital Bonn III, Medical Clinic, Department of Oncology, Hematology and Rheumatology, and Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Chrysidis, MD, Hospital of Southwest Denmark; C. Dejaco, MD, PhD, Medical University Graz, and Hospital of Bruneck; C. Duftner, MD, PhD, Medical University Innsbruck; A. Iagnocco, MD, Università degli Studi di Torino; G.A. Bruyn, MD, PhD, MC Groep Hospitals; G. Carrara, MSc, Epidemiology Unit - SIR; M.A. D'Agostino, MD, PhD, Hôpital Ambroise Paré; E. De Miguel, MD, University Hospital La Paz; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; U. Fredberg, MD, PhD, Diagnostic Centre Region Hospital Silkeborg, and Odense University Hospital; W. Hartung, MD, Asklepios Medical Center; A. Hocevar, MD, MSc, University Medical Centre Ljubljana; A. Juche, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; T.A. Kermani, MD, University of California at Los Angeles; M.J. Koster, MD, Mayo Clinic; T. Lorenzen, MD, Diagnostic Centre Region Hospital Silkeborg; P. Macchioni, MD, Arcispedale Santa Maria Nuova; M. Milchert, MD, PhD, Pomeranian Medical University; U.M. Døhn, MD, PhD, COPECARE; C. Mukhtyar, MBBS, MSc, MD, Norfolk and Norwich University Hospital; C. Ponte, MD, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, and Rheumatology Department, Hospital de Santa Maria - CHLN; S. Ramiro, MD, MSc, PhD, Leiden University Medical Center; C.A. Scirè, MD, PhD, Epidemiology Unit - SIR, and University of Ferrara; L. Terslev, MD, PhD, COPECARE; K.J. Warrington, MD, Mayo Clinic; B. Dasgupta, MBBS, MD, FRCP, Southend University Hospital, NHS Foundation Trust and Anglia Ruskin University; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch. valentin.s.schaefer@hotmail.de.
³ From the University Hospital Bonn III, Medical Clinic, Department of Oncology, Hematology and Rheumatology, Bonn; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin; Asklepios Medical Center, Bad Abbach, Germany; Hospital of Southwest Denmark, Esbjerg; Diagnostic Centre Region Hospital Silkeborg, Silkeborg; Odense University Hospital, Odense; Copenhagen Center for Arthritis Research (COPECARE), Glostrup, Denmark; Medical University Graz, Graz; Medical University Innsbruck, Innsbruck, Austria; Hospital of Bruneck, Bruneck; Università degli Studi di Torino, Turin; Epidemiology Unit - Italian Society for Rheumatology (SIR), Milan; Arcispedale Santa Maria Nuova, Reggio Emilia; University of Ferrara, Italy; MC Groep Hospitals, Lelystad; Leiden University Medical Center, the Netherlands; Hôpital Ambroise Paré, Boulogne-Billancourt, France; University Hospital La Paz, Madrid, Spain; Martina Hansens Hospital, Bærum, Oslo, Norway; University Medical Centre Ljubljana, Ljubljana, Slovenia; University of California at Los Angeles, Los Angeles, California; Mayo Clinic, Rochester, Minnesota, USA; Pomeranian Medical University, Szczecin, Poland; Norfolk and Norwich University Hospital, Norwich; Southend University Hospital, UK National Health Service (NHS) Foundation Trust and Anglia Ruskin University, Westcliff, UK; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Rheumatology Department, Hospital de Santa Maria - CHLN, Lisbon, Portugal.
⁴ V.S. Schäfer, MD, University Hospital Bonn III, Medical Clinic, Department of Oncology, Hematology and Rheumatology, and Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Chrysidis, MD, Hospital of Southwest Denmark; C. Dejaco, MD, PhD, Medical University Graz, and Hospital of Bruneck; C. Duftner, MD, PhD, Medical University Innsbruck; A. Iagnocco, MD, Università degli Studi di Torino; G.A. Bruyn, MD, PhD, MC Groep Hospitals; G. Carrara, MSc, Epidemiology Unit - SIR; M.A. D'Agostino, MD, PhD, Hôpital Ambroise Paré; E. De Miguel, MD, University Hospital La Paz; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; U. Fredberg, MD, PhD, Diagnostic Centre Region Hospital Silkeborg, and Odense University Hospital; W. Hartung, MD, Asklepios Medical Center; A. Hocevar, MD, MSc, University Medical Centre Ljubljana; A. Juche, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; T.A. Kermani, MD, University of California at Los Angeles; M.J. Koster, MD, Mayo Clinic; T. Lorenzen, MD, Diagnostic Centre Region Hospital Silkeborg; P. Macchioni, MD, Arcispedale Santa Maria Nuova; M. Milchert, MD, PhD, Pomeranian Medical University; U.M. Døhn, MD, PhD, COPECARE; C. Mukhtyar, MBBS, MSc, MD, Norfolk and Norwich University Hospital; C. Ponte, MD, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, and Rheumatology Department, Hospital de Santa Maria - CHLN; S. Ramiro, MD, MSc, PhD, Leiden University Medical Center; C.A. Scirè, MD, PhD, Epidemiology Unit - SIR, and University of Ferrara; L. Terslev, MD, PhD, COPECARE; K.J. Warrington, MD, Mayo Clinic; B. Dasgupta, MBBS, MD, FRCP, Southend University Hospital, NHS Foundation Trust and Anglia Ruskin University; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch.

PMID: 29961687
DOI: 10.3899/jrheum.171428

Abstract

Objective: To test the reliability of Outcome Measures in Rheumatology Clinical Trials (OMERACT) consensus-based ultrasound definitions for normal and vasculitic temporal and axillary arteries in patients with giant cell arteritis (GCA) and in controls.

Methods: A preliminary 1-day meeting and a full 3-day meeting fulfilling OMERACT Ultrasound Group guidelines were held. Temporal and axillary arteries were examined at 2 timepoints by 12 sonographers on 4 patients with GCA and 2 controls. The aim was to test inter- and intrareader reliability for normal findings, halo sign, and compression sign. In both meetings, patients had established GCA. Pathology was more recent in the full meeting, which was preceded by 6 h of training. Scanning time was 15-20 min instead of 10-13 min.

Results: In the preliminary exercise, interreader reliabilities were fair to moderate for the overall diagnosis of GCA (Light κ 0.29-0.51), and poor to fair for identifying vasculitis in the respective anatomical segments (Light κ 0.02-0.46). Intrareader reliabilities were moderate (Cohen κ 0.32-0.64). In the main exercise, interreader reliability was good to excellent (Light κ 0.76-0.86) for the overall diagnosis of GCA, and moderate to good (Light κ 0.46-0.71) for identifying vasculitis in the respective anatomical segments. Intrareader reliability was excellent for diagnosis of GCA (Cohen κ 0.91) and good (Cohen κ 0.71-0.80) for the anatomical segments.

Conclusion: OMERACT-derived definitions of halo and compression signs of temporal and axillary arteries are reliable in recent-onset GCA if experienced sonographers (> 300 examinations) have 15-20 min for a standardized examination with prior training and apply > 15 MHz probes.

Keywords: DIAGNOSIS; GIANT CELL ARTERITIS; RELIABILITY; ULTRASOUND; VASCULITIS.

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Assessing Vasculitis in Giant Cell Arteritis by Ultrasound: Results of OMERACT Patient-based Reliability Exercises

Affiliations

Assessing Vasculitis in Giant Cell Arteritis by Ultrasound: Results of OMERACT Patient-based Reliability Exercises

Authors

Affiliations

Abstract

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