Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 12;6(2):rkac040.
doi: 10.1093/rap/rkac040. eCollection 2022.

Diagnostic use of ultrasound in giant cell arteritis in Counties Manukau District Health Board, New Zealand

Rathan Nagarajah  1 , Rajiv Gupta  1 , Sunil Kumar  1
Affiliations

Diagnostic use of ultrasound in giant cell arteritis in Counties Manukau District Health Board, New Zealand

Rathan Nagarajah et al. Rheumatol Adv Pract. .

Abstract

Objectives: A retrospective observational study was undertaken to assess the diagnostic performance (sensitivity and specificity) of colour duplex ultrasound (CDUS) compared with temporal artery biopsy (TAB) for the diagnosis of GCA in the Counties Manukau District Health Board (CMDHB), New Zealand using clinical diagnosis as the reference standard.

Methods: The study population included patients with clinically suspected GCA who were referred to Middlemore Hospital and underwent CDUS, TAB or both between January 2019 and December 2020.

Results: Sixty-nine patients were included in the study. Sixty-one percent were >75 years of age, with no cases <50 years of age and a female predominance of 71%. The sensitivity of CDUS was 26% (95% CI 10, 48) and specificity was 97% (95% CI 84, 100). The sensitivity of TAB was 57% (95% CI 34, 77) and specificity was 100%. CDUS had a positive predictive value of 86% (95% CI 42, 99) and a negative predictive value of 65% (95% CI 49, 78).

Conclusion: A positive CDUS in patients with a high risk for GCA may preclude the need for TAB due to the high specificity of CDUS in GCA. In contrast, patients with a high risk for GCA with a negative CDUS may still need TAB to confirm or exclude GCA. The duration from commencement of steroids to the time of CDUS is crucial in confirming GCA and, for this, shortening the waiting time in the CMDHB would be necessary to ensure adequate test performance in practice.

Keywords: GCA; colour duplex ultrasound; diagnosis; temporal artery biopsy.

PubMed Disclaimer

Figures

<sc>Fig</sc>. 1
Fig. 1
Overview of clinically positive/negative GCA, positive/negative CDUS and positive/negative TAB Pt(s): patient(s).
<sc>Fig</sc>. 2
Fig. 2
Days from prednisone commencement to CDUS/TAB for patients with clinically positive GCA
<sc>Fig</sc>. 3
Fig. 3
Pooled sensitivity and specificity of CDUS for diagnosing GCA derived from 12 international studies Metanalyses give a pooled sensitivity of 70% (95% CI 58, 79) and a pooled specificity of 89% (95% CI 83, 94).
See this image and copyright information in PMC

References

    1. Nesher G, Breuer G.. Giant cell arteritis and polymyalgia rheumatica: 2016 update. Rambam Maimonides Med J 2016;7:e0035. - PMC - PubMed
    1. Sait M, Lepore M, Kwasnicki R. et al. The 2016 revised ACR criteria for diagnosis of giant cell arteritis – our case series: can this avoid unnecessary temporal artery biopsies? Int J Surg Open 2017;9:19–23.
    1. Luqmani R, Lee E, Singh S. et al. The role of ultrasound compared to biopsy of temporal arteries in the diagnosis and treatment of giant cell arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study. Health Technol Assess 2016;20:1–238. - PMC - PubMed
    1. Ching J, Smith S, Dasgupta B, Damato E.. The role of vascular ultrasound in managing giant cell arteritis in ophthalmology. Surv Ophthalmol 2020;65:218–26. - PubMed
    1. Dejaco C, Ramiro S, Duftner S. et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018;77:636–43. - PubMed

LinkOut - more resources