Czihal Michael, Schröttle Angelika, Baustel Kerstin, Lottspeich Christian, Dechant Claudia, Treitl Karla-Maria, Treitl Marcus, Schulze-Koops Hendrik, Hoffmann Ulrich
Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
Division of Rheumatology, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
Clin Exp Rheumatol. 2017 Mar-Apr;35 Suppl 103(1):128-133. Epub 2017 Apr 4.
We aimed to determine the diagnostic accuracy of B-mode compression sonography of the temporal arteries (tempCS) and B-mode sonographic measurement of the axillary artery intima media thickness (axIMT) for the diagnosis of giant cell arteritis (GCA).
After having established measurement of tempCS and axIMT in our routine diagnostic workup, 92 consecutive patients with a suspected diagnosis of GCA were investigated. Clinical characteristics were recorded and wall thickening of the temporal arteries (tempCS) and axillary arteries (axIMT) was measured (mm). Using the final clinical diagnosis as the reference standard, receiver operator characteristics (ROC) analysis was performed. In a subgroup of 26 patients interobserver agreement was assessed using Spearman's rank correlation.
Cranial GCA, extracranial GCA, and combined cranial/extracranial GCA were diagnosed in 18, 7, and 9 individuals, respectively. For the diagnosis of cranial GCA, tempCS had an excellent area under the curve (AUC) of 0.95, with a cut-off of ≥0.7 mm offering a sensitivity and specificity of 85% and 95%. The AUC of axIMT for the diagnosis of extracranial GCA was 0.91 (cut-off ≥1.2 mm: sensitivity and specificity 81.3 and 96.1%). Applying a combined tempCS/axIMT cut-off of ≥0.7mm/1.2 mm, we calculated an overall sensitivity and specificity for the final clinical diagnosis of cranial and/or extracranial GCA of 85.3% and 91.4%. Interobserver agreement was strong for both parameters assessed (Spearman's rho 0.72 and 0.77, respectively).
The combination of tempCS/axIMT allows objective sonographic assessment in suspected GCA with promising diagnostic accuracy.
我们旨在确定颞动脉B型加压超声检查（tempCS）和腋动脉内膜中层厚度B型超声测量（axIMT）对巨细胞动脉炎（GCA）诊断的准确性。
在我们的常规诊断检查中建立了tempCS和axIMT的测量方法后，对92例疑似GCA的连续患者进行了研究。记录临床特征并测量颞动脉（tempCS）和腋动脉（axIMT）的管壁增厚情况（mm）。以最终临床诊断为参考标准，进行受试者操作特征（ROC）分析。在26例患者的亚组中，使用Spearman等级相关性评估观察者间的一致性。
分别在18例、7例和9例个体中诊断出颅部GCA、颅外部GCA和颅部/颅外部联合GCA。对于颅部GCA的诊断，tempCS的曲线下面积（AUC）极佳，为0.95，截断值≥0.7mm时，敏感性和特异性分别为85%和95%。axIMT诊断颅外部GCA的AUC为0.91（截断值≥1.2mm：敏感性和特异性分别为81.3%和96.1%）。应用tempCS/axIMT联合截断值≥0.7mm/1.2mm，我们计算出颅部和/或颅外部GCA最终临床诊断的总体敏感性和特异性分别为85.3%和91.4%。对于所评估的两个参数，观察者间的一致性都很强（Spearman相关系数分别为0.72和0.77）。
tempCS/axIMT联合使用能够对疑似GCA进行客观的超声评估，诊断准确性良好。
