Ultrasound Definitions for Cranial and Large Vessel Giant Cell Arteritis: Results of a Reliability Exercise on Images and Videos of the Omeract Ultrasound Large Vessel Vasculitis Task Force

Stavros Chrysidis¹, Christina Duftner², Christian Dejaco³, Cristina Ponte⁴, Annamaria Iagnocco⁵, Bhaskar Dasgupta⁶, Maria Antonietta D'Agostino⁷, Eugenio De Miguel⁸, Ulrich Fredberg⁹, Wolfgang Hartung¹⁰, Alojzija Hocevar¹¹, Tanaz A. Kermani¹², Matthew J. Koster¹³, Tove Lorenzen¹⁴, Pierluigi Macchioni¹⁵, Marcin Milchert¹⁶, Naina Rastalsky¹⁷, Chetan Mukhtyar¹⁸, Valentin S. Schaefer¹⁹, Kenneth J. Warrington²⁰, Lene Terslev²¹, George A. W. Bruyn²², Petra Hanova²³, Uffe Møller Døhn²⁴, Esperanza Naredo²⁵, Carlo Alberto Scirè²⁶, Greta Carrara²⁷, Sofia Ramiro²⁸, Andreas P Diamantopoulos²⁹ and Wolfgang A. Schmidt¹⁹, ¹Department of Rheumatology, Hospital of Southwest Denmark, Esbjerg, Denmark, ²Medical University Innsbruck, Innsbruck, Austria, ³Rheumatology and Immunology, Medical University Graz, Graz, Austria, ⁴Rheumatology and Metabolic Bone Diseases Department, Rheumatology Research Unit - IMM, Lisbon Academic Medical Centre, Lisbon, Portugal, ⁵Sapienza Università Di Roma,, Roma, Italy, ⁶Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, United Kingdom, ⁷Rheumatology, Versailles-Saint Quentin en Yvelines University, Boulogne-Billancourt, France, ⁸Hospital Universitario La Paz, Madrid, Spain, ⁹Department of Internal Medicine, Diagnostic Centre Region Hospital Silkeborg Denmark, 8600 Silkeborg, Denmark, ¹⁰Department of Rheumatology/Clinical Immunology, Asklepios Medical Center, 93077 Bad Abbach, Germany, ¹¹Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, ¹²Rheumatology, University of California Los Angeles, Santa Monica, CA, ¹³Rheumatology, University of California Los Angeles, CA, USA Mayo Clinic, Rochester, MN, ¹⁴Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark, ¹⁵Arcispedale Santa Maria Nuova, Reggio Emilia,, Reggio Emilia, Italy, ¹⁶Pomeranian Medical University, Szczecin,, Szczecin, Poland, ¹⁷St. Elizabeth's Medical Center, Boston, MA, Boston, MA, ¹⁸Norfolk and Norwich University Hospital, Norwich, United Kingdom, ¹⁹Immanuel Krankenhaus Berlin, Med Ctr for Rheumatology Berlin-Buch, Berlin, Germany, ²⁰Rheumatology, University of California Los Angeles, CA, USA Mayo, Rochester, MN, ²¹Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen Center for Arthritis Research (COPECARE), Copenhagen, Denmark, ²²Rheumatology, MC Groep, Loenga, Netherlands, ²³Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic, ²⁴Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen Center for Arthritis Research (COPECARE), Glostrup, Denmark, ²⁵Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid, Spain, ²⁶Epidemiology Unit – Italian Society for Rheumatology (SIR), Milano, Italy, ²⁷Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy, ²⁸Leiden University Medical Center, Leiden, Netherlands, ²⁹Rheumatology, Haugesund Sanitetsforenings Revmatismesykehus, Haugesund, Norway

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: giant cell arteritis, large vessel vasculitis, Temporal arteritis, ultrasound and vasculitis

Session Information

Date: Wednesday, November 16, 2016

Session Title: Imaging of Rheumatic Diseases III: Crystal Arthritis, Osteoarthritis, Connective Tissue Disease and Vasculitis

Session Type: ACR Concurrent Abstract Session

Session Time: 11:00AM-12:30PM

Background/Purpose: By a Delphi process, the OMERACT Ultrasound (US) large vessel vasculitis task force has recently defined the US appearance of normal temporal arteries (TA) and normal extra-cranial large arteries (i.e. axillary arteries, AA), as well as the key elementary US-detected lesions in -giant cell arteritis (GCA) (i.e.:“halo sign” and “compression sign”; Table 1). The aim of the present study was to assess the reliability of those definitions on still images and videos in a web-based reliability exercise.

Methods: The reliability exercise was performed using a REDCap web application.One-hundred-fifty anonymized images/videos, provided by the members of the task force, were assessed: 20 videos and 20 still images of AA and 45 videos and 45 still images of TA with either no abnormality or the presence of a halo sign, and 20 videos of TA with either a positive or negative compression sign. The task force members (n26) were asked to rate all images and videos for normality/abnormality applying the definitions agreed upon in the previous Delphi exercise. In order to assess the intra-observer reliability the study was repeated two weeks later using the same images/videos presented in a different order. Cohen’s and Light’s κ were used for evaluating intra- and inter-reader reliability, respectively. Κ values 0–0.2 were considered slight, 0.2–0.4 fair, 0.4–0.6 moderate, 0.6–0.8 substantial and 0.8–1 excellent.

Results: The response rate was 25/26 (96%) in round 1 and 25/25 (100%) in round 2. The reliability of the 25 participants was excellent with mean inter-rater agreements over 90%, mean Lights’s kappa values of >0.8 for inter-rater reliability (Table 2) and mean Cohen kappa values of 0.83-0.98 for intra-rater reliability.

Conclusion: Inter- and intra-observer agreement on the evaluation of US still images and videos from normal and vasculitis patients was excellent applying the new OMERACT definitions for key elementary US lesions for GCA. Further exercises are planned in order to test the reliability in patients with large vessel vasculitis. Table 1

Vessel	Definition of US appearance of normal arteries	Definition of US appearance of vasculitis – “halo sign”	Definition of US appearance of vasculitis – compression sign
Temporal Arteries	Pulsating, compressible artery with anechoic lumen surrounded by mid- to hyperechoic tissue. Using US equipment with high resolution, the intima-media complex presenting as a homogenous, hypo- or anechoic echostructure delineated by two parallel hyperechoic margins (“double line pattern”) may be visible.	Homogenous, hypoechoic wall thickening, well delineated towards the luminal side, visible both, in longitudinal and transverse planes, most commonly concentric in transverse scans.	The thickened arterial wall remains visible upon compression, i.e. the echogenicity contrasts hypoechoic due to vasculitic vessel wall thickening in comparison to the mid- to hyperechoic surrounding tissue.
Axillary Arteries	Pulsating, hardly compressible artery with anechoic lumen; the intima-media complex presents as a homogenous, hypo- or anechoic echostructure delineated by two parallel hyperechoic margins (“double line pattern”), which is surrounded by mid- to hyperechoic tissue.	Same as for temporal arteries	The definition is not used for the axillary arteries

Table 2

Section

Mean agreement

mean Light‘s κ

Halo (all images & videos)

94%

0.89

Halo (images)

98%

0.95

Halo (videos)

92%

0.84

Halo temporal arteries (images & videos)

94%

0.87

Halo temporal arteries (images)

97%

0.94

Halo temporal arteries (videos)

91%

0.83

Halo axillary arteries (images & videos)

97%

0.93

Halo axillary arteries (images)

99%

0.98

Halo axillary arteries (videos)

94%

0.88

Compression sign (videos)

92%

0.83

Disclosure: S. Chrysidis, None; C. Duftner, None; C. Dejaco, None; C. Ponte, None; A. Iagnocco, None; B. Dasgupta, None; M. A. D'Agostino, None; E. De Miguel, None; U. Fredberg, None; W. Hartung, None; A. Hocevar, None; T. A. Kermani, None; M. J. Koster, None; T. Lorenzen, None; P. Macchioni, None; M. Milchert, None; N. Rastalsky, None; C. Mukhtyar, None; V. S. Schaefer, None; K. J. Warrington, None; L. Terslev, None; G. A. W. Bruyn, None; P. Hanova, None; U. M. Døhn, None; E. Naredo, None; C. A. Scirè, None; G. Carrara, None; S. Ramiro, None; A. P. Diamantopoulos, None; W. A. Schmidt, None.

To cite this abstract in AMA style:

Chrysidis S, Duftner C, Dejaco C, Ponte C, Iagnocco A, Dasgupta B, D'Agostino MA, De Miguel E, Fredberg U, Hartung W, Hocevar A, Kermani TA, Koster MJ, Lorenzen T, Macchioni P, Milchert M, Rastalsky N, Mukhtyar C, Schaefer VS, Warrington KJ, Terslev L, Bruyn GAW, Hanova P, Døhn UM, Naredo E, Scirè CA, Carrara G, Ramiro S, Diamantopoulos AP, Schmidt WA. Ultrasound Definitions for Cranial and Large Vessel Giant Cell Arteritis: Results of a Reliability Exercise on Images and Videos of the Omeract Ultrasound Large Vessel Vasculitis Task Force [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/ultrasound-definitions-for-cranial-and-large-vessel-giant-cell-arteritis-results-of-a-reliability-exercise-on-images-and-videos-of-the-omeract-ultrasound-large-vessel-vasculitis-task-force/. Accessed May 22, 2019.

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