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Meta-Analysis: Test Performance of Ultrasonography for Giant-Cell Arteritis
- Fotini B. Karassa, MD;
- Miltiadis I. Matsagas, MD;
- Wolfgang A. Schmidt, MD; and
- John P.A. Ioannidis, MD
- From University of Ioannina School of Medicine and Foundation for Research and Technology—Hellas, Ioannina, Greece; Medical Center for Rheumatology Berlin—Buch, Berlin, Germany; and Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
Abstract
Background: Giant-cell arteritis is a diagnostic challenge.
Purpose: To determine the diagnostic performance of ultrasonography for giant-cell arteritis.
Data Sources: Studies published up to April 2004 in the MEDLINE, EMBASE, and Cochrane databases; reference lists; and direct contact with investigators.
Study Selection: Studies in any language that examined temporal artery ultrasonography for diagnosis of giant-cell arteritis, enrolled at least 5 patients, and used biopsy or the American College of Rheumatology (ACR) criteria as the reference standard.
Data Extraction: Two reviewers independently graded methodologic quality and abstracted data on sensitivity and specificity of ultrasonography for giant-cell arteritis. Diagnostic performance was determined for the halo sign, stenosis, or occlusion and for any of these ultrasonographic abnormalities.
Data Synthesis: Weighted sensitivity and specificity estimates and summary receiver-operating characteristic (ROC) curve analysis were used. Twenty-three studies, involving a total of 2036 patients, met the inclusion criteria. The weighted sensitivity and specificity of the halo sign were 69% (95% CI, 57% to 79%) and 82% (CI, 75% to 87%), respectively, compared with biopsy and 55% (CI, 36% to 73%) and 94% (CI, 82% to 98%), respectively, compared with ACR criteria. Stenosis or occlusion was an almost equally sensitive marker compared with either biopsy (sensitivity, 68% [CI, 49% to 82%]) or ACR criteria (sensitivity, 66% [CI, 32% to 89%]). Consideration of any vessel abnormality nonsignificantly improved diagnostic performance compared with ACR criteria. Between-study heterogeneity was significant, but summary ROC curves were consistent with weighted estimates. When the pretest probability of giant-cell arteritis is 10%, negative results on ultrasonography practically exclude the disease (post-test probability, 2% to 5% for various analyses).
Limitations: The primary studies were small and of modest quality and had considerable heterogeneity.
Conclusion: Ultrasonography may be helpful in diagnosing giant-cell arteritis, but cautious interpretation of the test results based on clinical presentation and pretest probability of the disease is imperative.
Article and Author Information
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Acknowledgments: The authors thank Xavier Puéchal, MD; Matthias Reinhard, MD; and Helen Murgatroyd, MD, for providing clarifications or additional data on their studies and for reviewing the final draft. They also thank Efi Souli, MA; Evangelos Douitsis, MD; and Dionysis Spyridakos, MD, for reviewing German, Italian, and Japanese articles, respectively.
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: John P.A. Ioannidis, MD, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110 Ioannina, Greece; e-mail, jioannid{at}cc.uoi.gr.
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Current Author Addresses: Drs. Karassa and Ioannidis: Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110 Ioannina, Greece.
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Dr. Matsagas: Department of Surgery—Vascular Surgery Unit, University of Ioannina School of Medicine, 45110 Ioannina, Greece.
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Dr. Schmidt: Medical Center for Rheumatology Berlin—Buch, Karower Strasse 11, 13125 Berlin, Germany.
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