Department of Medicine, Montreal Sacre-Coeur Hospital, University of Montreal, Montreal, QC, Canada.
Vasculitis Clinic, Department of Medicine, Montreal Sacre-Coeur Hospital, University of Montreal, Montreal, QC, Canada.
Clin Rheumatol. 2024 Jan;43(1):357-365. doi: 10.1007/s10067-023-06721-6. Epub 2023 Aug 1.
INTRODUCTION/OBJECTIVES: To assess and compare the performance of the giant cell arteritis probability score (GCAPS), Ing score, Bhavsar-Khalidi score (BK score), color Doppler ultrasound (CDUS) halo count, and halo score, to predict a final diagnosis of giant cell arteritis (GCA).
A prospective cohort study was conducted from April to December 2021. Patients with suspected new-onset GCA referred to our quaternary CDUS clinic were included. Data required to calculate each clinical and CDUS probability score was systematically collected at the initial visit. Final diagnosis of GCA was confirmed clinically 6 months after the initial visit, by two blinded vasculitis specialists. Diagnostic accuracy and receiver operator characteristic (ROC) curves for each clinical and CDUS prediction scores were assessed.
Two hundred patients with suspected new-onset GCA were included: 58 with confirmed GCA and 142 without GCA. All patients with GCA satisfied the 2022 ACR/EULAR classification criteria. A total of 5/15 patients with GCA had a positive temporal artery biopsy. For clinical probability scores, the GCAPS showed the best sensitivity (Se, 0.983), whereas the BK score showed the best specificity (Sp, 0.711). As for CDUS, a halo count of 1 or more was found to have a Se of 0.966 and a Sp of 0.979. Combining concordant results of clinical and CDUS prediction scores showed excellent performance in predicting a final diagnosis of GCA.
Using a combination of clinical score and CDUS halo count provided an accurate GCA prediction method which should be used in the setting of GCA Fast-Track clinics. Key Points • In this prospective cohort of participants with suspected GCA, 3 clinical prediction tools and 2 ultrasound scores were compared head-to-head to predict a final diagnosis of GCA. • For clinical prediction tools, the giant cell arteritis probability score (GCAPS) had the highest sensitivity, whereas the Bhavsar-Khalidi score (BK score) had the highest specificity. • Ultrasound halo count was both sensitive and specific in predicting GCA. • Combination of a clinical prediction tool such as the GCAPS, with ultrasound halo count, provides an accurate method to predict GCA.
介绍/目的：评估和比较巨细胞动脉炎概率评分（GCAPS）、Ing 评分、Bhavsar-Khalidi 评分（BK 评分）、彩色多普勒超声（CDUS）晕环计数和晕环评分在预测巨细胞动脉炎（GCA）最终诊断中的表现。
这是一项前瞻性队列研究，于 2021 年 4 月至 12 月进行。纳入了因疑似新发 GCA 而被转诊至我们的四级 CDUS 诊所的患者。在初次就诊时，系统地收集了每个临床和 CDUS 概率评分所需的数据。初次就诊后 6 个月，由两名盲法血管炎专家通过临床评估来确认 GCA 的最终诊断。评估了每个临床和 CDUS 预测评分的诊断准确性和受试者工作特征（ROC）曲线。
共纳入 200 例疑似新发 GCA 患者：58 例确诊为 GCA，142 例无 GCA。所有 GCA 患者均符合 2022 年 ACR/EULAR 分类标准。共有 5/15 例 GCA 患者的颞动脉活检阳性。对于临床概率评分，GCAPS 的敏感性（Se，0.983）最高，而 BK 评分的特异性（Sp，0.711）最高。对于 CDUS，发现晕环计数为 1 或更多时，Se 为 0.966，Sp 为 0.979。结合临床和 CDUS 预测评分的一致结果，对 GCA 的最终诊断具有良好的预测性能。
使用临床评分和 CDUS 晕环计数的组合提供了一种准确的 GCA 预测方法，该方法应在 GCA 快速通道诊所中使用。关键点：• 在这项有疑似 GCA 参与者的前瞻性队列研究中，将 3 种临床预测工具和 2 种超声评分进行了头对头比较，以预测 GCA 的最终诊断。• 对于临床预测工具，巨细胞动脉炎概率评分（GCAPS）的敏感性最高，而 Bhavsar-Khalidi 评分（BK 评分）的特异性最高。• 超声晕环计数在预测 GCA 方面具有较高的敏感性和特异性。• 临床预测工具（如 GCAPS）与超声晕环计数相结合，提供了一种准确的预测 GCA 的方法。
