Rheumatology Unit, IRCSS - Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42100 Reggio Emilia, Italy.
Rheumatology (Oxford). 2013 Dec;52(12):2268-74. doi: 10.1093/rheumatology/ket258. Epub 2013 Sep 17.
To assess the findings of temporal artery colour duplex sonography (CDS) in GCA characterized by a histological pattern of periadventitial small vessel vasculitis (SVV) and/or vasa vasorum vasculitis (VVV) and compare it with those observed in classic GCA with transmural vasculitis.
We studied 30 patients with SVV and/or VVV, 63 patients with classic GCA and 67 biopsy-negative patients identified over a 9-year period. CDS of the temporal arteries was performed in all patients by one ultrasonographer. Temporal artery biopsy was used as the reference standard. Sensitivities, specificities and likelihood ratios (LRs) were calculated.
The frequency of the halo sign on CDS was significantly lower in the patients with SVV and/or VVV compared with those with classic GCA (20% vs 82.5%, P = 0.0001). The halo sign had a sensitivity of only 20% (95% CI 8.4, 39.1%) and a specificity of 80.6% (95% CI 68.7, 88.9%) for the diagnosis of SVV and/or VVV. The negative LR was 0.992 (CI 0.824, 1.195), and the positive LR was 1.030 (CI 0.433, 2.451). The halo sign for the diagnosis of biopsy-proven classic GCA had a higher sensitivity of 82.5% (CI 70.5, 90.5%), the same specificity of 80.6% (CI 68.7, 88.9%) and a higher positive LR (4.253; CI 2.577, 7.021).
The halo sign is infrequently found in GCA characterized by a histological pattern of SVV and/or VVV. This limits the sensitivity of CDS in correctly identifying patients with GCA.
评估颞动脉彩色双功能超声（CDS）在以血管周围小血管炎（SVV）和/或血管腔血管炎（VVV）组织学表现为特征的巨细胞动脉炎（GCA）中的表现，并将其与经典 GCA 中观察到的表现进行比较，后者表现为壁内血管炎。
我们研究了 30 例 SVV 和/或 VVV 患者、63 例经典 GCA 患者和 9 年内确诊的 67 例活检阴性患者。所有患者均由一名超声医师进行颞动脉 CDS。颞动脉活检作为参考标准。计算了灵敏度、特异性和似然比（LR）。
与经典 GCA 患者相比，SVV 和/或 VVV 患者的 CDS 环晕征频率明显较低（20% vs 82.5%，P = 0.0001）。环晕征的灵敏度仅为 20%（95%CI 8.4%，39.1%），特异性为 80.6%（95%CI 68.7%，88.9%），用于诊断 SVV 和/或 VVV。阴性 LR 为 0.992（CI 0.824，1.195），阳性 LR 为 1.030（CI 0.433，2.451）。环晕征诊断经活检证实的经典 GCA 的灵敏度较高，为 82.5%（CI 70.5%，90.5%），特异性相同，为 80.6%（CI 68.7%，88.9%），阳性 LR 较高（4.253；CI 2.577，7.021）。
SVV 和/或 VVV 组织学表现为特征的 GCA 中很少发现环晕征。这限制了 CDS 在正确识别 GCA 患者方面的敏感性。
