Schmidt Wolfgang A, Schäfer Valentin S
Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Lindenberger Weg 19, Berlin 13125, Germany.
Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany.
Ther Adv Musculoskelet Dis. 2024 Jun 5;16:1759720X241251742. doi: 10.1177/1759720X241251742. eCollection 2024.
Rheumatologists are increasingly utilizing ultrasound for suspected giant cell arteritis (GCA) or Takayasu arteritis (TAK). This enables direct confirmation of a suspected diagnosis within the examination room without further referrals. Rheumatologists can ask additional questions and explain findings to their patients while performing ultrasound, preferably in fast-track clinics to prevent vision loss. Vascular ultrasound for suspected vasculitis was recently integrated into rheumatology training in Germany. New European Alliance of Associations for Rheumatology recommendations prioritize ultrasound as the first imaging tool for suspected GCA and recommend it as an imaging option for suspected TAK alongside magnetic resonance imaging, positron emission tomography and computed tomography. Ultrasound is integral to the new classification criteria for GCA and TAK. Diagnosis is based on consistent clinical and ultrasound findings. Inconclusive cases require histology or additional imaging tests. Robust evidence establishes high sensitivities and specificities for ultrasound. Reliability is good among experts. Ultrasound reveals a characteristic non-compressible 'halo sign' indicating intima-media thickening (IMT) and, in acute disease, artery wall oedema. Ultrasound can further identify stenoses, occlusions and aneurysms, and IMT can be measured. In suspected GCA, ultrasound should include at least the temporal and axillary arteries bilaterally. Nearly all other arteries are accessible except the descending thoracic aorta. TAK mostly involves the common carotid and subclavian arteries. Ultrasound detects subclinical GCA in over 20% of polymyalgia rheumatica (PMR) patients without GCA symptoms. Patients with silent GCA should be treated as GCA because they experience more relapses and require higher glucocorticoid doses than PMR patients without GCA. Scores based on intima-thickness (IMT) of temporal and axillary arteries aid follow-up of GCA, particularly in trials. The IMT decreases more rapidly in temporal than in axillary arteries. Ascending aorta ultrasound helps monitor patients with extracranial GCA for the development of aneurysms. Experienced sonologists can easily identify pitfalls, which will be addressed in this article.
风湿病学家越来越多地将超声用于疑似巨细胞动脉炎（GCA）或大动脉炎（TAK）的诊断。这使得在检查室内即可直接确认疑似诊断，无需进一步转诊。风湿病学家在进行超声检查时可以向患者询问更多问题并解释检查结果，最好是在快速通道诊所进行，以防止视力丧失。疑似血管炎的血管超声检查最近已纳入德国的风湿病学培训。新的欧洲风湿病协会联盟建议将超声作为疑似GCA的首选成像工具，并推荐其作为疑似TAK的成像选项，与磁共振成像、正电子发射断层扫描和计算机断层扫描并列。超声是GCA和TAK新分类标准的组成部分。诊断基于一致的临床和超声检查结果。不确定的病例需要进行组织学检查或其他影像学检查。有力的证据表明超声具有很高的敏感性和特异性。专家之间的可靠性良好。超声显示出特征性的不可压缩的“晕征”，提示内膜中层增厚（IMT），在急性疾病中还提示动脉壁水肿。超声可以进一步识别狭窄、闭塞和动脉瘤，并且可以测量IMT。在疑似GCA时，超声检查应至少双侧检查颞动脉和腋动脉。除胸降主动脉外，几乎所有其他动脉都可以检查。TAK主要累及颈总动脉和锁骨下动脉。超声检查在超过20%没有GCA症状的多肌痛（PMR）患者中检测到亚临床GCA。无症状GCA患者应按GCA治疗，因为与没有GCA的PMR患者相比，他们更容易复发，需要更高剂量的糖皮质激素。基于颞动脉和腋动脉内膜厚度（IMT）的评分有助于GCA的随访，特别是在试验中。颞动脉的IMT下降比腋动脉更快。升主动脉超声有助于监测颅外GCA患者是否发生动脉瘤。经验丰富的超声科医生可以轻松识别陷阱，本文将对此进行讨论。
