Rheumatology Department, La Paz University Hospital, Madrid, Spain.
Clin Rheumatol. 2023 Apr;42(4):1163-1169. doi: 10.1007/s10067-022-06420-8. Epub 2022 Nov 11.
Color Doppler ultrasound (CDUS) of the temporal arteries (TA) is becoming the first test to be performed for suspected giant cell arteritis (GCA). Our aim was to assess the added value of including CDUS of large vessels (LV) in the diagnosis of GCA.
We performed an observational and retrospective study of consecutive patients with suspected GCA. Baseline CDUS of the TA and LV (axillary, subclavian, and carotid) were conducted. We defined the CDUS finding as positive if the halo sign was present.
Of 198 patients with suspected GCA, 87 were eventually diagnosed with GCA: 45 (51.7%) had a cranial pattern exclusively, 31 (35.6%) had both a cranial and an LV pattern, and 11 (12.6%) had an isolated LV pattern. CDUS of the TA had a sensitivity of 83.9%, specificity of 97.3%, and positive and negative predictive values (PPV, NPV) of 96.1% and 88.5%, respectively. When LV was added, sensitivity increased to 96.6% and NPV to 98.2%. Specificity was 97.3% and PPV was 96.6%. As for LVs, the axillary, subclavian, and carotid arteries were involved in 87.8%, 77.4%, and 34.4%, respectively. Isolated axillary examination resulted in a loss of 12.2% of patients with LV involvement; however, inclusion of the axillary and subclavian arteries retained 100% of patients with LV involvement.
Detection of GCA by ultrasound should routinely include examinations of the TA and LV (at least the axillary and subclavian arteries) to improve diagnostic accuracy. More than 12% of patients in our cohort had isolated LV involvement. Key Points • Extracranial involvement in GCA is very common: half of patients have extracranial vasculitis and more than 12% isolated LV involvement that can be demonstrated with CDUS. • Adding a CDUS examination of LV to TA increased sensitivity (from 83.9 to 96.6%) and the negative predictive value (from 88.5 to 98.2%) for diagnosis of GCA. • In our cohort, if we only examined the axillary arteries, 12.2% of the CGA with LV involvement would not have been diagnosed. • We propose a CDUS protocol that includes examination of the TA and LV (at least the axillary and subclavian arteries) routinely in cases of suspected GCA.
颞动脉（TA）的彩色多普勒超声（CDUS）正成为疑似巨细胞动脉炎（GCA）的首选检查方法。我们的目的是评估在 GCA 诊断中加入大血管（LV）CDUS 的额外价值。
我们对连续疑似 GCA 患者进行了一项观察性和回顾性研究。对 TA 和 LV（腋动脉、锁骨下动脉和颈动脉）进行基线 CDUS 检查。如果存在晕环征，则将 CDUS 结果定义为阳性。
198 例疑似 GCA 患者中，87 例最终诊断为 GCA：45 例（51.7%）仅为颅型，31 例（35.6%）为颅型和 LV 型，11 例（12.6%）为孤立性 LV 型。TA 的 CDUS 敏感性为 83.9%，特异性为 97.3%，阳性和阴性预测值（PPV、NPV）分别为 96.1%和 88.5%。当加入 LV 时，敏感性增加至 96.6%，NPV 增加至 98.2%。特异性为 97.3%，PPV 为 96.6%。对于 LV，涉及腋动脉、锁骨下动脉和颈动脉分别为 87.8%、77.4%和 34.4%。孤立的腋动脉检查导致 12.2%的 LV 受累患者漏诊；然而，包括腋动脉和锁骨下动脉检查保留了 100%的 LV 受累患者。
超声检测 GCA 时应常规检查 TA 和 LV（至少腋动脉和锁骨下动脉），以提高诊断准确性。我们队列中的 12%以上的患者有孤立性 LV 受累。关键点：• GCA 的颅外受累非常常见：一半的患者有颅外血管炎，超过 12%的孤立性 LV 受累可以通过 CDUS 显示。• 将 LV 的 CDUS 检查添加到 TA 中，提高了 GCA 诊断的敏感性（从 83.9%提高到 96.6%）和阴性预测值（从 88.5%提高到 98.2%）。• 在我们的队列中，如果我们只检查腋动脉，12.2%的 GCA 伴 LV 受累将不会被诊断。• 我们提出了一种 CDUS 方案，建议在疑似 GCA 患者中常规进行 TA 和 LV（至少腋动脉和锁骨下动脉）检查。
