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The use of temporal artery ultrasound in the diagnosis of giant cell arteritis in routine practice
Author(s) -
Black Rachel,
Roach Denise,
Rischmueller Maureen,
Lester Susan L.,
Hill Catherine L.
Publication year - 2013
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12108
Subject(s) - medicine , giant cell arteritis , halo sign , biopsy , likelihood ratios in diagnostic testing , radiology , arteritis , ultrasound , positive predicative value , vasculitis , diagnostic accuracy , surgery , predictive value , pathology , disease , computed tomography
Aim The exact diagnostic role of temporal artery ultrasound ( TAU ) remains unclear. The aim of this study was to determine the sensitivity and specificity of a positive halo sign in patients undergoing TAU in a clinical setting, and to perform a review of existing evidence. Method Patients who had undergone TAU at a single centre in Australia were included in the study. The presence or absence of a halo sign and whether it was unilateral or bilateral was determined retrospectively from radiology reports. Pathology results were used to determine which patients underwent a temporal artery biopsy and if the biopsy was positive or negative. A case note review was performed to determine presenting clinical features and if a clinical diagnosis of giant cell arteritis was made. The sensitivity, specificity and likelihood ratios of TAU compared to both biopsy and clinical diagnosis were calculated. Results Fifty patients were identified as having had a TAU (28% male, mean age 69). When compared to biopsy‐proven cases, the sensitivity of a halo sign was 40%, specificity 81%, positive likelihood ratio 2.1 and negative likelihood ratio 0.7. When compared to clinical diagnosis, the sensitivity was 42%, specificity 94%, positive likelihood ratio 7.1 and negative likelihood 0.6. Conclusions Sensitivity and specificity results were comparable to the literature. A halo sign may preclude the need for biopsy in cases of high clinical suspicion and contraindications to surgery. Biopsy remains necessary in most cases, irrespective of whether a halo sign is present.