Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
Department of Nuclear Medicine, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
Clin Exp Rheumatol. 2022 May;40(4):819-825. doi: 10.55563/clinexprheumatol/v1bvfz. Epub 2022 May 4.
There are limited data on the additional diagnostic yield of axillary artery ultrasound (axUS) in addition to temporal artery ultrasound (tempUS) for the diagnosis of giant cell arteritis (GCA).
Retrospective study of consecutive patients with suspected GCA who underwent a standardized axUS and tempUS between 01/2015 and 03/2017. The diagnostic yield of axUS in addition to ultrasound of the temporal arteries with respect to the final clinical diagnosis was assessed, with a positive axUS defined as circumferential, hypoechogenic thickening of the far wall axillary artery intima media thickness (axIMT) ≥1.3 mm. A subgroup of patients underwent PET-CT within one week before or after the sonographic study. Separate analyses were performed regarding certain subgroups according to clinical presentation and to clinical pre-test probability for cranial GCA.
Out of 228 patients, 92 received a final diagnosis of GCA. From the 92 patients with a final diagnosis of GCA, 50 (54.3%), 13 (14.1%) and 15 (16.3%) had a positive tempUS, positive axUS, and combined positive tempUS and axUS, respectively. The sensitivity of sonographic imaging for the final diagnosis of GCA increased from 69.6% to 84.8%, when axUS results were considered in addition to tempUS, while the specificity remained high (no false positive axUS). The diagnostic yield of axUS was highest in patients with a low clinical probability of cranial GCA and lowest in patients with symptoms of ocular ischemia. We observed a substantial rate (42.1%) of discordant results between axUS and PET-CT in a subgroup of 38 patients.
In conclusion, axUS offers a substantial diagnostic yield in addition to tempUS in subjects with suspected GCA, mainly in those subjects with low clinical probability for cranial GCA.
在 temporal artery ultrasound（tempUS）的基础上增加 axillary artery ultrasound（axUS）对 giant cell arteritis（GCA）的诊断有额外的诊断价值，但目前这方面的数据有限。
本研究为回顾性研究，纳入了 2015 年 1 月至 2017 年 3 月间连续疑似 GCA 患者，这些患者均接受了标准化 axUS 和 tempUS 检查。评估 axUS 检查相对于最终临床诊断的诊断价值，axUS 阳性定义为腋动脉远侧壁内中膜厚度（axIMT）≥1.3mm 的环形、低回声增厚。部分患者在超声检查前一周内或后一周内接受了 PET-CT 检查。根据临床表现和颅 GCA 的临床预测试验概率，对不同亚组进行了单独分析。
228 例患者中，92 例最终诊断为 GCA。在 92 例最终诊断为 GCA 的患者中，50 例（54.3%）、13 例（14.1%）和 15 例（16.3%）的 tempUS、axUS 和 tempUS 和 axUS 均为阳性。考虑到 axUS 结果时，超声成像对 GCA 最终诊断的敏感性从 69.6%增加到 84.8%，而特异性仍然很高（无假阳性 axUS）。在颅 GCA 临床可能性低的患者中，axUS 的诊断价值最高，在有眼部缺血症状的患者中最低。在 38 例患者的亚组中，我们观察到 axUS 和 PET-CT 之间存在相当大比例（42.1%）的结果不一致。
总之，在疑似 GCA 的患者中，axUS 在 tempUS 的基础上提供了实质性的诊断价值，主要是在颅 GCA 临床可能性低的患者中。
