Background/Purpose:

Color Doppler Ultrasonography (CDUS) has been shown to be a non-invasive promising tool to diagnose Giant Cell Arteritis (GCA). The aim of our study was to evaluate the diagnostic value of CDUS in patients suspected to have GCA in clinical care.

Methods:

Patients referred to our outpatient clinic between January 2010 and April 2012 with a tentative diagnosis of GCA were consecutively examined. A clinical evaluation was performed and the temporal arteries and the large vessels (carotid and axillary arteries) were assessed using a Siemens Acuson Antares ultrasound system (high frequency transducer 7-14 MHz). CDUS was considered positive when the typical sign of halo (arterial wall swelling in transverse and longitudinal view) was observed in the temporal arteries. The patients were diagnosed with large vessels vasculitis (LVV) when intima-media complex thickness was homogenous and more than 1.5 mm in the carotid artery and more than 1 mm in the axillary artery. After the CDUS examination, unilateral biopsies of the temporal artery were carried out in the majority of the patients. The diagnostic value of CDUS, temporal artery biopsy and the American College of Rheumatology classification criteria for the GCA (ACR-GCA) were tested against the gold standard, for this study defined as final clinical GCA diagnosis established by an experienced rheumatologist.

Results:

Seventy-eight patients (48 females, 30 males) were successively referred to our outpatient clinic. Thirty-six were diagnosed with GCA (27 females, 9 males) and all of them had a positive CDUS of the temporal artery. In addition, we found 4 patients with positive CDUS of the temporal artery but with other diagnoses (1 polyarteritis nodosa, 1 granulomatosis with polyangiitis and 2 with infections). Among the 36 patients with GCA, 32 fulfilled the ACR-GCA classification criteria. Temporal artery biopsy was positive in 20 of the 28 GCA patients who had a biopsy performed. Large vessel involvement was observed in 13 patients (36%). The mean time between the first presentation of symptoms and the diagnosis was 2.3 months (3.0 months in GCA patients with LVV and 1.7 months in classic GCA). In our series, sensitivity and specificity was 100% and 91% for CDUS, 64% and 95% for the temporal artery biopsy and 94% and 90% for the ACR-GCA classification criteria, respectively.

Conclusion:

We conclude that CDUS has an excellent sensitivity and a high specificity to diagnose GCA in daily clinical care. CDUS do also have the advantage to identify large vessel involvement in GCA patients. We recommend the use of CDUS as a first line assessment tool in diagnosing GCA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-diagnostic-value-of-color-doppler-ultrasonography-in-giant-cell-arteritis/