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Duplex Ultrasonography in Temporal Arteritis
- Carlo Salvarani, MD;
- Angelo Ghirarduzzi, MD; and
- Luigi Boiardi, MD, PhD
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IN RESPONSE:
In our study, we found that ultrasonographic evidence of a dark halo (in particular a halo of ≥ 1 mm) around the lumen of the temporal arteries had good specificity (93%), but low sensitivity (40%). In other words, the presence of halo ruled in a diagnosis of giant-cell arteritis but its absence did not exclude it. Schmid and colleagues (1) recently found that the halo sign had a sensitivity of 50% and a specificity of 100% for diagnosing giant-cell arteritis. As in our study, all of their patients were prospectively examined, had temporal artery biopsy, and underwent ultrasonography before the biopsy was performed. Ultrasonography, although specific, “misses” about half of the cases of giant-cell arteritis and cannot replace temporal artery biopsy in clinical practice. Temporal artery biopsy remains the gold standard for diagnosis of giant-cell arteritis.
We evaluated stenoses and occlusions, but the sensitivity of ultrasonography did not improve. Furthermore, we were reluctant to evaluate the presence of stenosis or occlusion because these lesions could be related to atherosclerosis, which is as common in elderly patients as in those affected by giant-cell arteritis. We think that Drs. Schmidt and Gromnica-Ihle's observation that inflammatory stenoses disappear with corticosteroids is relevant and could improve the sensitivity of ultrasonographic examination.
Ultrasonography may be useful in diagnosing concomitant giant-cell arteritis in patients with polymyalgia rheumatica, in particular those without clinical signs or symptoms of giant-cell arteritis. In our study, ultrasonography was not better than a careful physical examination for detecting biopsy-proven giant-cell arteritis, even when patients with polymyalgia rheumatica were considered. None of our patients with polymyalgia rheumatica and biopsy-proven giant-cell arteritis had normal results on temporal artery inspection and a hypoechoic halo on ultrasonography. Although Drs. Schmidt and Gromnica-Ihle previously observed the presence of halo in 6 of 102 patients with “pure” polymyalgia rheumatica, only 3 of these 6 patients had positive results on biopsy (2). More studies must be performed to find an answer to this relevant diagnostic issue. At our center, a study is under way to evaluate the usefulness of temporal artery ultrasonography for diagnosing giant-cell arteritis in patients with “pure” polymyalgia rheumatica.
Carlo Salvarani, MD
Angelo Ghirarduzzi, MD
Luigi Boiardi, MD, PhD
Arcispedale S. Maria Nuova; 42100 Reggio Emilia, Italy
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
