Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK.
Rheumatology (Oxford). 2021 Jun 18;60(6):2528-2536. doi: 10.1093/rheumatology/keab179.
Colour Doppler ultrasonography is the first measure to allow objective bedside assessment of GCA. This article discusses the evidence using the OMERACT filter. Consensus definitions for ultrasonographic changes were agreed upon by a Delphi process, with the 'halo' and 'compression' signs being characteristic. The halo is sensitive to change, disappearing within 2-4 weeks of starting glucocorticoids. Ultrasonography has moderate convergent validity with temporal artery biopsy in a pooled analysis of 12 studies including 965 participants [κ = 0.44 (95% CI 0.38, 0.50)]. The interobserver and intra-observer reliabilities are good (κ = 0.6 and κ = 0.76-0.78, respectively) in live exercises and excellent when assessing acquired images and videos (κ = 0.83-0.87 and κ = 0.88, respectively). Discriminant validity has been tested against stroke and diabetes mellitus (κ=-0.16 for diabetes). Machine familiarity and adequate examination time improves performance. Ultrasonography in follow-up is not yet adequately defined. Some patients have persistent changes in the larger arteries but these do not necessarily imply treatment failure or predict relapses.
彩色多普勒超声检查是用于客观床边评估巨细胞动脉炎（GCA）的首要方法。本文将使用 OMERACT 过滤器来讨论相关证据。通过德尔菲法（Delphi process）对超声改变的共识定义达成一致，其中“晕环”和“压迫”征象具有特征性。晕环对治疗变化敏感，在开始使用糖皮质激素的 2-4 周内消失。在包括 965 名参与者的 12 项研究的汇总分析中，超声检查与颞动脉活检具有中等程度的一致性[κ=0.44（95%CI 0.38，0.50）]。在现场练习中，观察者间和观察者内的可靠性良好（κ=0.6 和 κ=0.76-0.78），在评估获得的图像和视频时，可靠性极好（κ=0.83-0.87 和 κ=0.88）。已针对中风和糖尿病（糖尿病κ=-0.16）测试了判别有效性。熟悉机器和充足的检查时间可提高性能。在随访中，超声检查尚未得到充分定义。一些患者的大动脉持续存在改变，但这并不一定意味着治疗失败或预示复发。
