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
. 2023 Apr;42(4):1163-1169.
doi: 10.1007/s10067-022-06420-8. Epub 2022 Nov 11.

Diagnostic validity of ultrasound including extra-cranial arteries in giant cell arteritis

Irene Monjo Henry  1 , E Fernández Fernández  2 , D Peiteado  2 , A Balsa  2 , E de Miguel  2
Affiliations

Diagnostic validity of ultrasound including extra-cranial arteries in giant cell arteritis

Irene Monjo Henry et al. Clin Rheumatol. 2023 Apr.

Abstract

Objectives: Color Doppler ultrasound (CDUS) of the temporal arteries (TA) is becoming the first test to be performed for suspected giant cell arteritis (GCA). Our aim was to assess the added value of including CDUS of large vessels (LV) in the diagnosis of GCA.

Methods: We performed an observational and retrospective study of consecutive patients with suspected GCA. Baseline CDUS of the TA and LV (axillary, subclavian, and carotid) were conducted. We defined the CDUS finding as positive if the halo sign was present.

Results: Of 198 patients with suspected GCA, 87 were eventually diagnosed with GCA: 45 (51.7%) had a cranial pattern exclusively, 31 (35.6%) had both a cranial and an LV pattern, and 11 (12.6%) had an isolated LV pattern. CDUS of the TA had a sensitivity of 83.9%, specificity of 97.3%, and positive and negative predictive values (PPV, NPV) of 96.1% and 88.5%, respectively. When LV was added, sensitivity increased to 96.6% and NPV to 98.2%. Specificity was 97.3% and PPV was 96.6%. As for LVs, the axillary, subclavian, and carotid arteries were involved in 87.8%, 77.4%, and 34.4%, respectively. Isolated axillary examination resulted in a loss of 12.2% of patients with LV involvement; however, inclusion of the axillary and subclavian arteries retained 100% of patients with LV involvement.

Conclusions: Detection of GCA by ultrasound should routinely include examinations of the TA and LV (at least the axillary and subclavian arteries) to improve diagnostic accuracy. More than 12% of patients in our cohort had isolated LV involvement. Key Points • Extracranial involvement in GCA is very common: half of patients have extracranial vasculitis and more than 12% isolated LV involvement that can be demonstrated with CDUS. • Adding a CDUS examination of LV to TA increased sensitivity (from 83.9 to 96.6%) and the negative predictive value (from 88.5 to 98.2%) for diagnosis of GCA. • In our cohort, if we only examined the axillary arteries, 12.2% of the CGA with LV involvement would not have been diagnosed. • We propose a CDUS protocol that includes examination of the TA and LV (at least the axillary and subclavian arteries) routinely in cases of suspected GCA.

Keywords: Diagnostic imaging; Giant cell arteritis; Ultrasonography; Ultrasound.

PubMed Disclaimer

References

    1. Dumont A, Parienti J-J, Delmas C, Boutemy J, Maigné G, Martin Silva N et al (2020) Factors associated with relapse and dependence on glucocorticoids in giant cell arteritis. J Rheumatol 47(1):108–16. Available from: https://doi.org/10.3899/jrheum.181127
    1. de Mornac D, Espitia O, Néel A, Connault J, Masseau A, Espitia-Thibault A et al (2021) Large-vessel involvement is predictive of multiple relapses in giant cell arteritis. Ther Adv Musculoskelet Dis 13:1759720X2110090. Available from: https://doi.org/10.1177/1759720x211009029
    1. Sugihara T, Hasegawa H, Uchida HA, Yoshifuji H, Watanabe Y, Amiya E et al (2020) Associated factors of poor treatment outcomes in patients with giant cell arteritis: clinical implication of large vessel lesions. Arthritis Res Ther 22(1):72. Available from: https://doi.org/10.1186/s13075-020-02171-6
    1. de Boysson H, Liozon E, Ly KH, Dumont A, Delmas C, Aouba A (2019) The different clinical patterns of giant cell arteritis. Clin Exp Rheumatol 37 Suppl 117(2):57–60 - PubMed
    1. de Boysson H, Liozon E, Espitia O, Daumas A, Vautier M, Lambert M et al (2019) Different patterns and specific outcomes of large-vessel involvements in giant cell arteritis. J Autoimmun 103:102283. Available from: https://doi.org/10.1016/j.jaut.2019.05.011

MeSH terms

LinkOut - more resources