scholarly journals Diagnostic performance and utility of very high-resolution ultrasonography in diagnosing giant cell arteritis of the temporal artery

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Johnny K M Sundholm ◽  
Tom Pettersson ◽  
Anders Paetau ◽  
Anders Albäck ◽  
Taisto Sarkola
Keyword(s):  
High Resolution ◽  
Temporal Artery ◽  
Final Diagnosis ◽  
Thickness Measurement ◽  
Observer Agreement ◽  
Diagnostic Utility ◽  
Temporal Artery Biopsy ◽  
Glucocorticoid Treatment ◽  
Non Invasive ◽  
Very High

Abstract Objective Very-high resolution US (VHRU; 55 MHz) provides improved resolution and could provide non-invasive diagnostic information in GCA of the temporal artery. The objective of this study was to assess the diagnostic utility of VHRU-derived intima thickness (VHRU-IT) in comparison to high-resolution US halo-to-Doppler ratio (HRU-HDR) in patients referred for temporal artery biopsy. Methods VHRU and HRU of the temporal artery were performed before a biopsy procedure in 78 prospectively recruited consecutive patients who had received glucocorticoid treatment for a median of 8 days (interquartile range 0–13 days) before imaging. Based on the final diagnosis and biopsy findings, the study population was divided into the following four groups: non GCA (n = 40); clinical GCA with no inflammation on biopsy (n = 15); clinical GCA with inflammation limited to adventitia (n = 9); and clinical GCA with transmural inflammation (TMI; n = 11). Results Both VHRU and HRU were useful for identifying subjects with TMI, with VHRU outperforming HRU (area under curve: VHRU-IT 0.99, 95% CI 0.97, 1.00; HRU-HDR 0.74, 95% CI 0.52, 0.96; P=0.026). The diagnostic utility for diagnosing clinical GCA (negative biopsy) or inflammation limited to the adventitia was poor for both VHRU and HRU-HDR. From 5 days after initiation of glucocorticoid treatment, VHRU-IT was increased in eight of nine patients, whereas HRU-HDR was positive in three of seven patients. Both methods showed excellent inter-observer agreement (Cohen’s κ: VHRU-IT 0.873; HRU-HDR 0.811). Conclusion In suspected GCA, VHRU allows non-invasive real-time imaging of TMI manifestations of the temporal artery wall. VHRU-derived intimal thickness measurement seems to be more sensitive than the halo sign and HRU-HDR in detecting TMI in patients with prolonged glucocorticoid treatment.

scholarly journals Facial nerve injury during temporal artery biopsy

2014 ◽  
Vol 96 (4) ◽  
pp. 257-260 ◽  
Author(s):  
AR Gunawardene ◽  
H Chant
Keyword(s):  
Facial Nerve ◽  
Nerve Injury ◽  
Temporal Artery ◽  
Temporal Artery Biopsy ◽  
Test Results ◽  
Facial Nerve Injury ◽  
Non Invasive ◽  
American College Of Rheumatology ◽  
Invasive Techniques

Temporal artery biopsy is considered the gold standard investigation of giant cell arteritis and is recommended in suspected cases despite a sensitivity of 81–91%. This review highlights the potential risk of facial nerve injury during temporal artery biopsy and introduces recent advances in the emerging role of imaging modalities. When these non-invasive techniques are used in conjunction with American College of Rheumatology scoring, which includes clinical features and biochemical test results, temporal artery biopsy may be avoided in selected cases.

scholarly journals Bilateral Vertebral Artery Vasculitis—A Rare Manifestation of Giant Cell Arteritis and a Difficult Diagnosis Made Possible by 2-[18F]FDG PET/CT

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 879
Author(s):  
Natasja Justesen ◽  
Michael Hansen ◽  
Mads Jensen ◽  
Oliver Klefter ◽  
Jane Brittain ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Fdg Pet ◽  
Temporal Artery ◽  
High Dose ◽  
Temporal Artery Biopsy ◽  
Glucocorticoid Treatment ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

: Giant cell arteritis (GCA) is the most common form of large vessel vasculitis. GCA is a medical and ophthalmological emergency, and rapid diagnosis and treatment with high-dose corticosteroids is critical in order to reduce the risk of stroke and sudden irreversible loss of vision. GCA can be difficult to diagnose due to insidious and unspecific symptoms—especially if typical superficial extracranial arteries are not affected. In these cases, verification of clinical diagnosis using temporal artery biopsy is not possible. This example illustrates the diagnostic value of hybrid imaging with 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT), and the limitations of the temporal artery biopsy in bilateral vertebral GCA, causing transient ischemic attack in the visual cortex. In addition it indicates that inflammation in the artery wall can be visualized on 2-[18F]FDG PET/CT despite long term and ongoing high dose glucocorticoid treatment.

scholarly journals AB0515 COMPARISON OF THE PERFORMANCE OF THE 1990 ACR CLASSIFICATION CRITERIA AND THE GIACTA INCLUSION CRITERIA FOR THE CLASSIFICATION OF GCA: RESULTS FROM A SINGLE-CENTRE STUDY.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1554.1-1555
Author(s):  
F. Muratore ◽  
L. Boiardi ◽  
E. Galli ◽  
G. Pazzola ◽  
A. Cavazza ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Temporal Artery ◽  
Final Diagnosis ◽  
Classification Criteria ◽  
Temporal Artery Biopsy ◽  
Inclusion Criteria ◽  
Small Vessels ◽  
Imaging Results

Background:The classification criteria currently used to define giant cell arteritis (GCA) were developed in 1990 by the American College of Rheumatology (ACR), and strongly focus on patients with cranial manifestations. Patients with large-vessel GCA (LV-GCA) have less frequently cranial symptoms and a positive temporal artery biopsy, and are less likely to be captured by the ACR criteria. GiACTA, a trial of tocilizumab in GCA, has recognized the concept of GCA as a clinical syndrome, and included patients with cranial and/or polymyalgic symptoms as long as GCA diagnosis was supported by either biopsy or appropriate LV imaging results. However, these inclusion criteria were elaborated by experts and were not validated in patients with GCA.Objectives:To compare the performance of the 1990 ACR classification criteria and the GiACTA inclusion criteria for the classification of GCA in a single-center cohort of patients with GCA.Methods:All consecutive patients with a diagnosis of GCA seen between January 2008 and December 2016 in our center were included (GCA cohort). Control cohort consisted of consecutive patients with a negative temporal artery biopsy (TAB) performed in the same time period and a final diagnosis different than GCA. For both study cohort, the final diagnosis was made at the end of the follow-up period by consensus by 2 rheumatologists, who retrospectively evaluated all the medical records from symptoms’ onset to December 2019, last visit, or death. Subjects were classified by each of the different criteria. TABs showing inflammation limited to adventitial or periadventitial small vessels were considered negative for both ACR and GiACTA criteria.Two-by-two classification tables were generated to estimate sensitivity and specificity, and receiver operating characteristic (ROC) curves with corresponding areas under the curve (AUC) were calculated.Results:213 patients were included in the study (75% female, mean age 71.7 years). 55 patients had TAB showing transmural inflammation (TMI); 30 patients had TAB showing inflammation limited to adventitial or periadventitial small vessels (PAI); 67 patients had evidence of LV-GCA at imaging (LV-GCA) and 61 patients had TAB without inflammatory changes (negTAB). 1990 ACR and GiACTA criteria were satisfied respectively by 55 (100%) and 51 (93%) TMI, 18 (60%) and 1 (3%) PAI, 23 (35%) and 31 (46%) LV-GCA and 27 (44%) and none (0%) negTAB patients.After a median follow-up of 52.6 months, 174 of the 213 (84%) patients had a final diagnosis of GCA (55 TMI, 22 PAI; 67 LV-GCA and 30 negTAB) and the remaining 33 patients had a diagnosis different than GCA (2 PAI and 31 negTAB). Sensitivity and specificity of 1990 ACR classification criteria for GCA were 67% and 90%, AUC (95% CI) 0.790 (0.715 – 0.864). Sensitivity and specificity of GiACTA inclusion criteria were 48% and 100%, AUC (95% CI) 0.740 (0.669 – 0.811). By adding systemic symptoms in the symptoms domain of GiACTA inclusion criteria, sensitivity increased to 59% and sensitivity remained 100%, AUC (95% CI) 0.792 (0.730 – 0.854).Conclusion:Both 1990 ACR classification criteria and GiACTA inclusion criteria showed a good specificity but a low sensitivity in classifying patients with a clinical diagnosis of GCA from this large monocentric cohort. There is an urgent need for new classification criteria for GCA.Disclosure of Interests:Francesco Muratore: None declared, Luigi Boiardi: None declared, Elena Galli: None declared, Giulia Pazzola: None declared, Alberto Cavazza: None declared, Giovanna Restuccia: None declared, Carlo Salvarani Grant/research support from: consulting and investigator fees from Abbvie, Pfizer, MSD, Roche, Celgene, Novartis, Consultant of: consulting and investigator fees from Abbvie, Pfizer, MSD, Roche, Celgene, Novartis

scholarly journals Non-Invasive Vascular Very-High Resolution Ultrasound to Quantify Artery Intima Layer Thickness: Validation of the Four-Line Pattern

2019 ◽  
Vol 45 (8) ◽  
pp. 2010-2018 ◽  
Author(s):  
Johnny K.M. Sundholm ◽  
Anders Paetau ◽  
Anders Albäck ◽  
Tom Pettersson ◽  
Taisto Sarkola
Keyword(s):  
High Resolution ◽  
Layer Thickness ◽  
Line Pattern ◽  
Non Invasive ◽  
Very High ◽  
Intima Layer

Very High Resolution Analysis of the Dynamics of a Coronal Plasmoid

1994 ◽  
Vol 144 ◽  
pp. 593-596
Author(s):  
O. Bouchard ◽  
S. Koutchmy ◽  
L. November ◽  
J.-C. Vial ◽  
J. B. Zirker
Keyword(s):  
High Resolution ◽  
Solar Eclipse ◽  
Total Solar Eclipse ◽  
Field Of View ◽  
Small Field ◽  
High Resolution Analysis ◽  
Ccd Observations ◽  
Resolution Analysis ◽  
Very High ◽  
Small Field Of View

AbstractWe present the results of the analysis of a movie taken over a small field of view in the intermediate corona at a spatial resolution of 0.5“, a temporal resolution of 1 s and a spectral passband of 7 nm. These CCD observations were made at the prime focus of the 3.6 m aperture CFHT telescope during the 1991 total solar eclipse.

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