LeSar Christopher J, Meier George H, DeMasi Richard J, Sood Jaideep, Nelms Courtney R, Carter Kathleen A, Gayle Robert G, Parent F Noel, Marcinczyk Michael J
Norfolk Surgical Group, Vascular Surgical Division, Eastern Virginia Medical School, 250 W Brambleton Avenue, Norfolk, VA 23510, USA.
J Vasc Surg. 2002 Dec;36(6):1154-60. doi: 10.1067/mva.2002.129648.
Temporal arteritis (TA) is frequently diagnosed with nonspecific clinical characteristics, followed by a temporal artery biopsy to confirm the presence of vasculitis. Consequently, numerous screening surgical biopsies are performed with a high negative-biopsy rate. A prospective study was performed evaluating color duplex ultrasound scan (CDU) as the preferred method for the diagnosis of vasculitis in the evaluation of suspected TA.
Thirty-two patients with suspected TA on the basis of clinical criteria were evaluated with CDU before a temporal artery biopsy. The presence of a hypoechoic "halo," suggesting edema of the inflamed vessel, and inflammatory stenoses were noted. Histologic examinations of standard temporal artery biopsies then were performed, and the results were compared with the CDU findings. In addition, a metaanalysis was performed to identify articles related to the use of ultrasound scan in the detection of TA.
All patients completed a bilateral CDU examination of the temporal arteries, and in 75% of patients biopsied, no evidence of vasculitis was found at histologic examination. When CDU examined for halo alone as the determinant for disease, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), compared with histologic confirmation of TA, were 85.7%, 92.0%, 75.0%, and 95.8%, respectively. With the criteria for a halo sign present, an inflammatory stenosis present, or both present on CDU, the sensitivity, specificity, positive predictive value, and NPV were 100%, 80.0%, 58.3%, and 100%, respectively.
CDU is a superior noninvasive method of determining the presence of vasculitis when compared with routine surgical biopsy. Examination of the temporal artery with CDU can effectively predict which patient will need surgical biopsy. The utility of CDU in the diagnosis of TA is maintained by a high sensitivity in detecting patients with the disease and also by a high NPV that can eliminate patients who would not benefit from biopsy.
颞动脉炎（TA）常根据非特异性临床特征进行诊断，随后进行颞动脉活检以确认血管炎的存在。因此，进行了大量筛查性手术活检，活检阴性率很高。本前瞻性研究评估彩色双功超声扫描（CDU）作为疑似TA评估中血管炎诊断的首选方法。
32例基于临床标准疑似TA的患者在颞动脉活检前接受了CDU评估。记录有无提示炎症血管水肿的低回声“晕圈”以及炎症性狭窄。然后对标准颞动脉活检进行组织学检查，并将结果与CDU检查结果进行比较。此外，进行了一项荟萃分析，以确定与超声扫描在TA检测中的应用相关的文章。
所有患者均完成了颞动脉的双侧CDU检查，在75%接受活检的患者中，组织学检查未发现血管炎证据。当仅将CDU检查的晕圈作为疾病的决定因素时，与TA的组织学确诊相比，敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为85.7%、92.0%、75.0%和95.8%。根据CDU上出现晕圈征、出现炎症性狭窄或两者均出现的标准，敏感性、特异性、阳性预测值和NPV分别为100%、80.0%、58.3%和100%。
与常规手术活检相比，CDU是一种确定血管炎存在的更优无创方法。用CDU检查颞动脉可有效预测哪些患者需要手术活检。CDU在TA诊断中的效用在于其在检测患病患者方面具有高敏感性，以及具有可排除那些无法从活检中获益的患者的高NPV。
