评估颞动脉双功能超声在颞动脉炎诊断中的应用。

Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.

J Surg Res. 2021 May;261:320-325. doi: 10.1016/j.jss.2020.12.036. Epub 2021 Jan 20.

BACKGROUND

Temporal arteritis or giant cell arteritis is a form of systemic inflammatory vasculitis closely associated with polymyalgia rheumatica. It may have serious systemic, neurologic, and ophthalmic consequences as it may lead to impaired vision and blindness. Definitive diagnosis is made after histopathologic analysis of a superficial temporal artery (TA) biopsy, which requires a small surgical procedure often under local anesthesia. We investigated whether a noninvasive technique such as duplex ultrasound of the TA could replace histopathological analysis.

METHODS

Eighty-one patients referred to our department for TA biopsy were first screened with a duplex ultrasound for a surrounding halo and/or occlusion of the TA. Presence of visual disturbances and unilateral pain (headache and/or tongue/jaw claudication) was noted before TA biopsy. Pathological analysis was considered the gold standard. Correlation between duplex findings, symptoms, and pathology was determined by Spearman's Rho test. The predictive value of a halo and TA occlusion on duplex were determined by ROC curve analysis.

RESULTS

A halo or TA occlusion was found in 16.0% and 3.7% of patients, respectively. Unilateral pain was reported in 96% of cases while 82% complained of visual disturbances. Correlation coefficients for halo and occlusion were 0.471 and 0.404, respectively (P < 0.0001), suggesting a moderate correlation between duplex and biopsy. There was no significant correlation between visual impairment or pain and histologic findings. The ROC curve analysis showed a sensitivity of 53.3% and 20.0%, and specificity of 91.9% and 100% for presence of a halo and occlusion of the TA on duplex, respectively.

CONCLUSIONS

Arterial duplex is a moderately sensitive but highly specific test for exclusion of temporal arteritis. We observed a moderate correlation between these findings on duplex and histopathological analysis as a gold standard. Arterial duplex may serve as a valuable diagnostic addition to prevent unnecessary surgical procedures and can even substitute biopsy in patients where surgery is not an option.

背景

颞动脉炎或巨细胞动脉炎是一种系统性炎症性血管炎，与巨细胞性多肌炎密切相关。它可能会导致视力受损和失明等严重的系统性、神经系统和眼部后果。明确的诊断是在对颞浅动脉（TA）活检进行组织病理学分析后做出的，这需要在局部麻醉下进行一个小的外科手术。我们研究了一种非侵入性技术，如 TA 的双功能超声，是否可以替代组织病理学分析。

方法

81 名因 TA 活检而转至我们科室的患者首先接受了双功能超声检查，以筛查 TA 周围的光环和/或闭塞。在 TA 活检前记录存在视觉障碍和单侧疼痛（头痛和/或舌/颌跛行）。病理分析被认为是金标准。通过 Spearman 的 Rho 检验确定双功能超声检查结果、症状和病理学之间的相关性。通过 ROC 曲线分析确定光环和 TA 闭塞在双功能超声检查中的预测价值。

结果

分别在 16.0%和 3.7%的患者中发现了光环或 TA 闭塞。96%的病例报告有单侧疼痛，82%的病例报告有视觉障碍。光环和闭塞的相关系数分别为 0.471 和 0.404（P<0.0001），表明双功能超声与活检之间存在中度相关性。视觉障碍或疼痛与组织学发现之间无显著相关性。ROC 曲线分析显示，双功能超声检查存在光环和 TA 闭塞的敏感性分别为 53.3%和 20.0%，特异性分别为 91.9%和 100%。