Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Centre National de Référence des Maladies Systémiques Autoimmunes Rares RESO, F-67000 Strasbourg, France.
Department of Rheumatology, Cavale Blanche Hospital and Brest Occidentale University, Brest, France.
Autoimmun Rev. 2019 Jan;18(1):56-61. doi: 10.1016/j.autrev.2018.07.012. Epub 2018 Nov 5.
Despite major recent advances in the therapeutic management of Giant cell arteritis (GCA), the diagnosis accuracy of temporal artery ultrasound remains controversial in this disease. We performed a systematic review to determine the sensitivity, specificity, and summary positive (LR+) and negative (LR-) likelihood ratios of temporal artery ultrasound for the diagnosis of GCA. For this, we searched EMBASE, MEDLINE and the Cochrane Database of Systematic Reviews without language restriction. Original articles reporting on diagnostic accuracy of temporal artery ultrasound compared to temporal artery biopsy, for the diagnosis of GCA, were selected. Sensitivity and specificity from each study were used to fit a bivariate diagnosis accuracy model. Of 1280 articles identified, 48 underwent full-text review, and 25 were included. Based on a total of 20 studies, the sensitivity and specificity of hypoechoic halo compared to positive temporal artery biopsy were respectively of 68% (95% CI: 57-78) and 81% (95%CI: 75-86). The summary mean positive and negative likelihood ratios were respectively of 3.64 (95%CI: 2.76-4.73) and 0.40 (0.28-0.52). Taking into account 11 studies reporting on the presence of any abnormal sign on temporal artery ultrasound yielded similar results with largely overlapping 95% confidence interval regions. This study provides the summary estimates of the diagnostic properties of temporal artery ultrasound compared to temporal artery biopsy, for the diagnosis of GCA. Those parameters allow the calculation of the post-test probability of GCA in a given patient, based on the results of temporal artery ultrasound and will help improving the diagnosis strategy for this common disease.
尽管巨细胞动脉炎（GCA）的治疗管理在最近取得了重大进展，但颞动脉超声在该疾病中的诊断准确性仍存在争议。我们进行了系统评价，以确定颞动脉超声诊断 GCA 的敏感性、特异性以及汇总阳性（LR+）和阴性（LR-）似然比。为此，我们在没有语言限制的情况下搜索了 EMBASE、MEDLINE 和 Cochrane 系统评价数据库。选择了报告与颞动脉活检相比，颞动脉超声对 GCA 诊断准确性的原始文章。从每项研究中使用敏感性和特异性来拟合双变量诊断准确性模型。在确定的 1280 篇文章中，有 48 篇进行了全文审查，有 25 篇被纳入。基于总共 20 项研究，与阳性颞动脉活检相比，低回声晕的敏感性和特异性分别为 68%（95%CI：57-78）和 81%（95%CI：75-86）。汇总平均阳性和阴性似然比分别为 3.64（95%CI：2.76-4.73）和 0.40（0.28-0.52）。考虑到 11 项报告颞动脉超声上任何异常征象的研究，得出了类似的结果，95%置信区间区域大致重叠。这项研究提供了与颞动脉活检相比，颞动脉超声诊断 GCA 的诊断特性的汇总估计。这些参数允许根据颞动脉超声的结果计算特定患者 GCA 的后验概率，并有助于改善这种常见疾病的诊断策略。
