Diagnostic performance and utility of very high-resolution ultrasonography in diagnosing giant cell arteritis of the temporal artery

被引:19
作者
Sundholm, Johnny K. M. [1 ]
Pettersson, Tom [2 ,3 ]
Paetau, Anders [4 ,5 ]
Alback, Anders [3 ,6 ]
Sarkola, Taisto [1 ]
机构
[1] Univ Helsinki, Helsinki, Helsinki, Finland
[2] Univ Helsinki, Dept Gen Internal Med & Geriatr, Helsinki, Finland
[3] Helsinki Univ Hosp, Helsinki, Finland
[4] Univ Helsinki, HUSLAB Meipa1 Pathol Lab, Helsinki, Finland
[5] Univ Helsinki, Haartman Inst, Helsinki, Finland
[6] Univ Helsinki, Dept Vasc Surg, Helsinki, Finland
关键词
giant-cell arteritis; diagnostics; ultrasound; ultrasound biomicroscopy; very-high resolution ultrasound; ULTRASOUND BIOMICROSCOPY; CORTICOSTEROID TREATMENT; DUPLEX ULTRASONOGRAPHY; BIOPSY; INVOLVEMENT; SONOGRAPHY; PATTERNS; VESSEL; YIELD;
D O I
10.1093/rap/rkz018
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective Very-high resolution US (VHRU; 55 MHz) provides improved resolution and could provide non-invasive diagnostic information in GCA of the temporal artery. The objective of this study was to assess the diagnostic utility of VHRU-derived intima thickness (VHRU-IT) in comparison to high-resolution US halo-to-Doppler ratio (HRU-HDR) in patients referred for temporal artery biopsy. Methods VHRU and HRU of the temporal artery were performed before a biopsy procedure in 78 prospectively recruited consecutive patients who had received glucocorticoid treatment for a median of 8 days (interquartile range 0-13 days) before imaging. Based on the final diagnosis and biopsy findings, the study population was divided into the following four groups: non GCA (n = 40); clinical GCA with no inflammation on biopsy (n = 15); clinical GCA with inflammation limited to adventitia (n = 9); and clinical GCA with transmural inflammation (TMI; n = 11). Results Both VHRU and HRU were useful for identifying subjects with TMI, with VHRU outperforming HRU (area under curve: VHRU-IT 0.99, 95% CI 0.97, 1.00; HRU-HDR 0.74, 95% CI 0.52, 0.96; P=0.026). The diagnostic utility for diagnosing clinical GCA (negative biopsy) or inflammation limited to the adventitia was poor for both VHRU and HRU-HDR. From 5 days after initiation of glucocorticoid treatment, VHRU-IT was increased in eight of nine patients, whereas HRU-HDR was positive in three of seven patients. Both methods showed excellent inter-observer agreement (Cohen's j: VHRU-IT 0.873; HRU-HDR 0.811). Conclusion In suspected GCA, VHRU allows non-invasive real-time imaging of TMI manifestations of the temporal artery wall. VHRU-derived intimal thickness measurement seems to be more sensitive than the halo sign and HRU-HDR in detecting TMI in patients with prolonged glucocorticoid treatment.
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页数:10
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