Kaandorp Branko I, Raterman Hennie G, Stam Frank, Gamala Mihaela, Meijer-Jorna Lorine B, Kalb Fraukje B, Wallis Jos W
Northwest Clinics, Alkmaar, The Netherlands.
ACR Open Rheumatol. 2024 Feb;6(2):56-63. doi: 10.1002/acr2.11628. Epub 2023 Nov 23.
It is urgent to diagnose giant cell arteritis (GCA) as quickly as possible to prevent irreversible blindness. The traditional gold standard for diagnosing GCA is temporal artery biopsy (TAB). However, TAB lacks diagnostic performance and carries out risks of surgical intervention. The noninvasive color Doppler ultrasound (CDU) seems to be a promising alternative. This study is designed to assess the diagnostic value of CDU in daily clinical practice.
In this prospective cohort study, patients with a clinical suspicion of active GCA were included and underwent a CDU of the temporal arteries. If deemed necessary by the referrer, a TAB and/or 18F-fluorodeoxyglucose positron emission tomography with computed tomography was performed. The retrospective clinical diagnosis was determined 1 year after inclusion by two physicians experienced in the field of vasculitis.
242 patients were included and GCA was diagnosed in 73 (30%) patients by the defined retrospective clinical diagnosis. Compared with the retrospective diagnosis, CDU has a sensitivity of 60% (48-72), specificity of 94% (89-97), positive predictive value (PPV) of 81% (70-89), negative predictive value (NPV) of 85% (80-88), and an accuracy of 84% (78-88). A total of 84 (35%) patients underwent TAB. TAB has a sensitivity of 66% (51-79), specificity of 100% (90-100), PPV of 100% (100), NPV of 67% (58-75), and an accuracy of 80% (70-88).
This study shows comparable diagnostic performance for CDU and TAB and even better CDU results with a bilateral halo present. Considering the advantages of the noninvasive CDU, it is the diagnostic tool of choice.
尽快诊断巨细胞动脉炎（GCA）以预防不可逆性失明至关重要。诊断GCA的传统金标准是颞动脉活检（TAB）。然而，TAB缺乏诊断效能且存在手术干预风险。非侵入性彩色多普勒超声（CDU）似乎是一种有前景的替代方法。本研究旨在评估CDU在日常临床实践中的诊断价值。
在这项前瞻性队列研究中，纳入临床怀疑为活动性GCA的患者，并对其颞动脉进行CDU检查。如果转诊医生认为必要，则进行TAB和/或18F-氟脱氧葡萄糖正电子发射断层扫描计算机断层扫描。纳入后1年，由两名血管炎领域经验丰富的医生确定回顾性临床诊断。
纳入242例患者，根据定义的回顾性临床诊断，73例（30%）患者被诊断为GCA。与回顾性诊断相比，CDU的敏感性为60%（48-72），特异性为94%（89-97），阳性预测值（PPV）为81%（70-89），阴性预测值（NPV）为85%（80-88），准确性为84%（78-88）。共有84例（35%）患者接受了TAB。TAB的敏感性为66%（51-79），特异性为100%（90-100），PPV为100%（100），NPV为67%（58-75），准确性为80%（70-88）。
本研究显示CDU和TAB具有可比的诊断效能，并且在出现双侧晕圈时CDU结果甚至更好。考虑到非侵入性CDU的优势，它是首选的诊断工具。
