Nagarajah Rathan, Gupta Rajiv, Kumar Sunil
Department of Rheumatology, Counties Manukau District Health Board, Middlemore Hospital, Auckland, New Zealand.
Rheumatol Adv Pract. 2022 May 12;6(2):rkac040. doi: 10.1093/rap/rkac040. eCollection 2022.
A retrospective observational study was undertaken to assess the diagnostic performance (sensitivity and specificity) of colour duplex ultrasound (CDUS) compared with temporal artery biopsy (TAB) for the diagnosis of GCA in the Counties Manukau District Health Board (CMDHB), New Zealand using clinical diagnosis as the reference standard.
The study population included patients with clinically suspected GCA who were referred to Middlemore Hospital and underwent CDUS, TAB or both between January 2019 and December 2020.
Sixty-nine patients were included in the study. Sixty-one percent were >75 years of age, with no cases <50 years of age and a female predominance of 71%. The sensitivity of CDUS was 26% (95% CI 10, 48) and specificity was 97% (95% CI 84, 100). The sensitivity of TAB was 57% (95% CI 34, 77) and specificity was 100%. CDUS had a positive predictive value of 86% (95% CI 42, 99) and a negative predictive value of 65% (95% CI 49, 78).
A positive CDUS in patients with a high risk for GCA may preclude the need for TAB due to the high specificity of CDUS in GCA. In contrast, patients with a high risk for GCA with a negative CDUS may still need TAB to confirm or exclude GCA. The duration from commencement of steroids to the time of CDUS is crucial in confirming GCA and, for this, shortening the waiting time in the CMDHB would be necessary to ensure adequate test performance in practice.
开展一项回顾性观察研究，以新西兰马努考县地区卫生委员会（CMDHB）临床诊断为参考标准，评估彩色双功超声（CDUS）与颞动脉活检（TAB）相比，在诊断巨细胞动脉炎（GCA）方面的诊断性能（敏感性和特异性）。
研究人群包括2019年1月至2020年12月期间被转诊至米德尔莫尔医院且接受了CDUS、TAB或两者检查的临床疑似GCA患者。
69名患者纳入研究。61%的患者年龄>75岁，无<50岁的病例，女性占比71%。CDUS的敏感性为26%（95%CI 10, 48），特异性为97%（95%CI 84, 100）。TAB的敏感性为57%（95%CI 34, 77），特异性为100%。CDUS的阳性预测值为86%（95%CI 42, 99），阴性预测值为65%（95%CI 49, 78）。
GCA高风险患者CDUS结果为阳性时，由于CDUS在GCA诊断中特异性高，可能无需进行TAB。相比之下，GCA高风险患者CDUS结果为阴性时，可能仍需进行TAB以确认或排除GCA。从开始使用类固醇到进行CDUS检查的时间间隔对于确诊GCA至关重要，为此，缩短CMDHB的等待时间对于确保实际检测性能充足很有必要。
