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. 2023 Feb 14;25(1):23.
doi: 10.1186/s13075-023-03002-0.

Ultrasound halo count in the differential diagnosis of atherosclerosis and large vessel giant cell arteritis

Irene Monjo-Henry  1 , Elisa Fernández-Fernández  2 , José María Mostaza  3 , Carlos Lahoz  3 , Juan Molina-Collada  4 , Eugenio de Miguel  2
Affiliations

Ultrasound halo count in the differential diagnosis of atherosclerosis and large vessel giant cell arteritis

Irene Monjo-Henry et al. Arthritis Res Ther. .

Abstract

Objective: To determine the diagnostic discriminant validity between large vessel giant cell arteritis (LV-GCA) and atherosclerosis using ultrasound (US) intima-media thickness (IMT) measurements.

Methods: We included 44 patients with LV-GCA and 42 with high-risk atherosclerosis. US examinations of the axillary, subclavian, and common carotid arteries (CCA) were systematically performed using a MylabX8 system (Genoa, Italy) with a 4-15-MHz probe. IMT ≥ 1 mm was accepted as pathological.

Results: The LV-GCA cohort included 24 females and 20 males with a mean age of 72.8 ± 7.6 years. The atherosclerosis group included 25 males and 17 females with a mean age of 70.8 ± 6.5 years. The mean IMT values of all arteries included were significantly higher in LV-GCA than in atherosclerosis. Among LV-GCA patients, IMT ≥ 1 mm was seen in 31 axillary, 30 subclavian, and 28 CCA. In the atherosclerotic cohort, 17 (38.6%) had IMT ≥ 1 mm with axillary involvement in 2 patients, subclavian in 3 patients, carotid distal in 14 patients (5 bilateral), and isolated carotid proximal affectation in 1 case. A cutoff point greater than 1 pathological vessel in the summative count of axillary and subclavian arteries or at least 3 vessels in the count of six vessels, including CCA, showed a precision upper 95% for GCA diagnosis.

Conclusion: The IMT is higher in LV-GCA than in atherosclerosis. The proposed US halo count achieves an accuracy of > 95% for the differential diagnosis between LV-GCA and atherosclerosis. The axillary and subclavian arteries have higher discriminatory power, while carotid involvement is less specific in the differential diagnosis.

Keywords: Atherosclerosis; Diagnosis; Giant cell arteritis; Imaging; Large vessel vasculitis; Ultrasonography.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
IMT measurement: intima-media thickness (IMT) is measured as the distance between lumen-intima (white arrow) and media-adventitia (red arrow) interfaces. Examples are shown in yellow arrows. In this case, we see an example of mid- to hyperechoic long segmental thickening of the intima-media displaying several visible lines with loss of the typical double line pattern in a longitudinal scan of the left subclavian artery, corresponding to the increased IMT with chronic changes
Fig. 2
Fig. 2
Longitudinal scan of a normal carotid artery
Fig. 3
Fig. 3
Longitudinal scan of a carotid artery with atherosclerosis: IMT 1.2 mm and atherosclerotic plaques (arrows)
Fig. 4
Fig. 4
Longitudinal scan of a normal subclavian artery: IMT 0.45 mm
Fig. 5
Fig. 5
Longitudinal scan of axillary artery: chronic changes in the intima-media complex in GCA patient: IMT 2.3 mm
See this image and copyright information in PMC

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