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Abstract Number: 3197

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

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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 June 1, 2023.
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