Colour duplex sonography of temporal arteries before decision for biopsy: a prospective study in 55 patients with suspected giant cell arteritisReport as inadecuate




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Arthritis Research and Therapy

, 8:R116

First Online: 19 July 2006Received: 22 March 2006Revised: 27 June 2006Accepted: 30 June 2006

Abstract

Although a temporal artery biopsy is the gold standard for the diagnosis of giant cell arteritis GCA, there is considerable evidence that characteristic signs demonstrated by colour duplex sonography CDS of the temporal arteries may be of diagnostic importance. We aimed to test the hypothesis that CDS can replace biopsy in the algorithm for the approach to diagnose GCA. Bilateral CDS was performed in consecutive patients older than 50 years with clinically suspected GCA, as well as in 15 age- and gender-matched control subjects with diabetes mellitus and-or stroke and 15 healthy subjects, to assess flow parameters and the possible presence of a dark halo around the arterial lumen. Unilateral temporal artery biopsy was then performed in patients with suspected GCA, which was directed to a particular arterial segment in case a halo was detected in CDS. Final diagnoses, after completion of a 3-month follow-up in 55 patients, included GCA n = 22, polymyalgia rheumatica n = 12, polyarteritis nodosa, Wegener-s, and Adamantiades-Behçet-s diseases n = 3, and neoplastic n = 8 and infectious diseases n = 10. A dark halo of variable size 0.7–2.0 mm around the vessel lumen was evident at baseline CDS in 21 patients in 12 and 9 uni- or bilaterally, respectively but in none of the controls. The presence of unilateral halo alone yielded 82% sensitivity and 91% specificity for GCA, whereas the specificity reached 100% when halos were found bilaterally. Blood-flow abnormal parameters temporal artery diameter, peak systolic blood-flow velocities, stenoses, occlusions were common in GCA and non-GCA patients, as well as in healthy and atherosclerotic disease-control, elderly subjects. At follow-up CDS examinations performed at 2 and 4 weeks after initiation of corticosteroid treatment for GCA, halos disappeared in all 18 patients 9 and 9, respectively. We conclude that CDS, an inexpensive, non-invasive, and easy-to-perform method, allows a directional biopsy that has an increased probability to confirm the clinical diagnosis. Biopsy is not necessary in a substantial proportion of patients in whom bilateral halo signs can be found by CDS.

AbbreviationsACR= American College of Rheumatology

CDS= colour duplex ultrasonography

CI= confidence interval

ESR= erythrocyte sedimentation rate

GCA= giant cell arteritis.

Electronic supplementary materialThe online version of this article doi:10.1186-ar2003 contains supplementary material, which is available to authorized users.

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Author: Maria Karahaliou - George Vaiopoulos - Spiros Papaspyrou - Meletios A Kanakis - Konstantinos Revenas - Petros P Sfikakis

Source: https://link.springer.com/



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