Background/Purpose
Ultrasound has a high sensitivity and specificity regarding the diagnosis of giant cell arteritis (GCA). Ultrasound can also depict extracranial large vessel vasculitis (LVV) in both GCA and Takayasu arteritis (TA) patients. Until now, no studies have examined the inter-observer agreement of the ultrasonographic findings in LVV patients.
Hence, the aim of this study was to examine the inter-observer agreement of the ultrasound examination of temporal arteries and large vessels in LVV patients.
Methods
This study is a part of the MUSES project (Magnetic resonance angiography vs Ultrasonography in Systemic large vEssel vasculitiS), a prospective cross-sectional study. Patients who were diagnosed with LVV by ultrasound, MRA or CTA were identified and included in the study at the Department of Rheumatology, Hospital of Southern Norway Trust in Kristiansand from January 2014 to June 2014. One ultrasonographer experienced in the use of vascular ultrasound (APD) examined and recruited the LVV patients. The common temporal (TC), temporal parietal branch (TP), temporal frontal branch (TF), carotid (AC), subclavian (AS), vertebral (AV), axillary (AA) arteries, abdominal aorta (AAR) and ascending thoracic aorta (TAR) were scanned in all patients. Films of ultrasound evaluation of every artery both in longitudinal and transverse view (TAR-only longitudinal view) were recorded, and these data were surveyed by an expert on vascular ultrasound (WAS) who was blinded to clinical and laboratory data. To calculate the inter-observer agreement the Cohen’s kappa test has been used.
Results
Nineteen patients were included in this study [(9 males, 10 females, median age 65 (32-78)]. Eighteen patients were diagnosed with GCA and one with TA. Six patients had new onset LVV and 13 had long lasting [(mean disease duration 3.3 years, 95% CI 1.95-4.67)]. Median CRP was 5 mg/l (1-133) and ESR 25 mm/hr (4-112).
The inter-observer agreement for the various arteries was: TC 0.94 (95% CI 0.82-1.00), TP 0.94 (95% CI 0.83-1.00), TF 0.87 (95% CI 0.70-1.00), AC 0.67 (95% CI 0.45-0.89), AS 0.94 (95% CI 0.84-1.00), AV 0.84 (95% CI 0.54-1.00), AA 1.00, TAR 1.00. None of the patients had affection of the abdominal aorta on ultrasound examination.
Conclusion
Ultrasonographic findings of aorta, temporal and supraaortic arteries in patients with LVV appears to be highly reproducible and can be recorded in films for further evaluation. Nonetheless, experience in the use of vascular ultrasound is required to achieve these promising results.
Disclosure:
A. P. Diamantopoulos,
None;
J. Geiger,
None;
F. Lohne,
None;
G. Myklebust,
None;
W. A. Schmidt,
Novartis Pharma AG,
2,
Mundipharma,
2.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-interobserver-agreement-on-ultrasonographic-findings-in-patients-with-large-vessel-vasculitis/