National Referral Center for Necrotizing Vasculitides and Systemic Sclerosis, Hospital Cochin, Assistance Publique-Hôpitaux de Paris, University Paris 5-René Descartes, Paris, France.
J Rheumatol. 2010 Nov;37(11):2326-30. doi: 10.3899/jrheum.100353. Epub 2010 Sep 1.
Use of TA-US for diagnostic investigation of giant cell arteritis (GCA) has been proposed but remains a matter of debate because of the heterogeneous findings. We retrospectively evaluated operating characteristics of temporal artery ultrasonography (TA-US) in a single teaching hospital.
All subjects with suspected GCA had been seen between 2002 and 2008 and had undergone TA-US with continuous-wave Doppler (until 2004) or color duplex ultrasonography (after 2004), followed within 30 days by a temporal artery biopsy (TAB). TA-US findings were compared with TAB-proven GCA and clinically diagnosed GCA. Results are expressed as sensitivities, specificities, and positive (LR+) and negative likelihood ratios (LR-) of stenoses, occlusions, and the halo sign; for the latter, only color duplex TA-US was considered.
Seventy-seven patients fulfilled the selection criteria; 13 had TAB-proven and 19 had clinically defined GCA. Stenoses/occlusions were seen on 45.5% of TA-US and the halo sign was seen only once (3.2%) in 31 duplex TA-US. Respective sensitivities, specificities, LR+, and LR- for GCA diagnosis (using TAB-proven/clinically defined GCA as reference standards) were 69%/53%, 59%/57%, 1.7/1.2, and 0.5/0.8 for stenoses and/or occlusions, and 17%/10%, 100%/100%, infinite/infinite, and 0.8/0.9 for the halo sign.
The halo sign showed 100% specificity for GCA but only 10%-17% sensitivity. Stenoses/occlusions were of low diagnostic value. These observations suggest that TA-US is neither an effective substitute for TAB nor a reliable screening test to decide which patients can be safely spared TAB.
TA-US 用于诊断巨细胞动脉炎（GCA）的应用已被提出，但由于其结果存在异质性，因此仍存在争议。我们回顾性评估了一家教学医院中颞动脉超声（TA-US）的操作特征。
所有疑似 GCA 的患者均于 2002 年至 2008 年间就诊，并接受了连续波多普勒 TA-US（直至 2004 年）或彩色双功超声 TA-US（2004 年后）检查，随后在 30 天内进行颞动脉活检（TAB）。将 TA-US 结果与 TAB 证实的 GCA 和临床诊断的 GCA 进行比较。结果以狭窄、闭塞以及晕环征的敏感度、特异度、阳性（LR+）和阴性似然比（LR-）表示；对于后者，仅考虑彩色双功 TA-US。
77 例患者符合入选标准；其中 13 例经 TAB 证实为 GCA，19 例为临床诊断的 GCA。TA-US 上发现狭窄/闭塞占 45.5%，31 例彩色双功 TA-US 中仅发现 1 次晕环征（3.2%）。GCA 诊断的敏感度、特异度、LR+和 LR-（以 TAB 证实/临床诊断的 GCA 为参考标准）分别为狭窄/闭塞的 69%/53%、59%/57%、1.7/1.2 和 0.5/0.8，以及晕环征的 17%/10%、100%/100%、无限大/无限大、0.8/0.9。
晕环征对 GCA 的特异性为 100%，但敏感度仅为 10%-17%。狭窄/闭塞对 GCA 的诊断价值较低。这些结果表明，TA-US 既不能有效替代 TAB，也不能作为决定哪些患者可安全避免 TAB 的可靠筛查试验。
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