Navigation Links
Cranial ultrasound may replace temporal artery biopsy in diagnosis of giant cell arteritis
Date:6/12/2014

A new study presented for the first time today at the European League Against Rheumatism Annual Congress (EULAR 2014), shows that cranial ultrasound has a greater sensitivity than temporal artery biopsy,* and a comparable specificity in the diagnosis of Giant Cell Arteritis (GCA).1

Giant Cell Arteritis (GCA), a condition in which medium and large arteries mainly in the head and neck, become inflamed and narrowed, can cause blindness due to occlusion of the artery supplying the back of the eye. It is therefore essential that a prompt, accurate diagnosis of GCA is made and treatment with high dose steroids started as soon as possible. Currently there are no 100% accurate diagnostic tests for GCA. Patients typically present with severe headache and scalp tenderness located to one or both sides of the forehead. However, GCA can be difficult to distinguish from other less serious causes of headache.

In this study, cranial ultrasound was the strongest predictor for a diagnosis of GCA when results were evaluated against a confirmed clinical diagnosis at three months. In contrast, the existing American College of Rheumatology (ACR) criteria that include TAB, when used alone, were insufficiently specific to accurately predict or exclude the diagnosis of GCA at three months. Relying on ACR criteria alone would therefore be leaving patients at risk of missing out on potentially sight-saving steroid treatment, or of being treated with high dose steroids unnecessarily.

"Although temporal artery biopsy (TAB) has historically been considered the 'gold standard' diagnostic test for GCA, the exciting results of this new study suggest cranial ultrasound may soon replace TAB in the assessment of patients with a suspected diagnosis of GCA in routine clinical practice," said lead author Dr Adam Croft from the Centre for Translational Inflammation Research, University of Birmingham, UK.

"Patients with symptoms and signs of GCA can now be offered a much simpler, more accurate diagnostic test. The high predictive accuracy of cranial ultrasound over temporal artery biopsy indicated that temporal artery biopsy may now be unnecessary, particularly where clinical suspicion of GCA is high or quite low," Dr Croft added.

Out of a total of 87 patients who underwent cranial ultrasound for suspected GCA, 36 patients (41%) had a confirmed clinical diagnosis at the three month follow-up. Of the 30 patients who had a positive cranial ultrasound, 29 (96%) went on to have a confirmed diagnosis of GCA at three months. Of the 36 patients with more than three ACR criteria, only 21 (58%) had a diagnosis of GCA confirmed at three months.

"Being able to reliably confirm the diagnosis is important not just to ensure those patients with GCA receive high-dose steroids to help prevent blindness, but also to prevent patients who don't have GCA continuing high-dose steroid therapy unnecessarily. High doses of steroids can cause a variety of unpleasant side effects including weight gain, infection risk, osteoporosis and fracture risk, high blood pressure, diabetes, cataracts," Dr Adam Croft explained.

When compared to clinical diagnosis at three months, the sensitivity of cranial ultrasound was 81%, specificity 98%, positive likelihood ratio 41, negative likelihood ratio 0.2, positive predictive value of 97% and negative predictive value of 88%. In contrast, when compared to clinical diagnosis at three months TAB had a sensitivity of 53%, specificity 100%, positive likelihood ratio 2.3, negative likelihood ratio 0.2, positive predictive value of 100% and negative predictive value of 47%. Over the last 25󈞊 years, GCA has been found to be the most common type of vasculitis in Europe and North America, especially in people aged >70 years. GCA mainly affects white individuals, and it almost exclusively occurs in subjects aged >50 years. The cause of giant cell arteritis is unclear; however, it is thought that a combination of genetic and environmental factors, such as an infection may be responsible.2 Prompt treatment of GCA with high dose steroids is essential to prevent permanent loss of vision. In one study, 14% permanently lost vision because of GCA, and in 94% of these patients the visual deficit developed before steroid therapy for GCA was begun.3

In this study, all patients undergoing cranial ultrasound between January 2005 and July 2013 were identified and clinical data obtained from electronic records, and, if necessary primary care providers. ACR criteria for GCA were used to classify patients.

Ultrasound reports were independently classified according to whether there was evidence of an arteritis or not. Explicit ultrasound features of GCA, such as a halo sign were not required to make this determination. The relationship between the ACR criteria alone or in combination with ultrasound and a final clinical diagnosis of GCA (made after a minimum of three-month follow-up) was analysed. A clinical diagnosis of GCA after three months of follow up served as the gold standard. The sensitivity and specificity of cranial ultrasound and of TAB were examined against this gold standard.


'/>"/>

Contact: EULAR Press Office
eularpressoffice@cohnwolfe.com
44-078-801-73209
European League Against Rheumatism
Source:Eurekalert

Related medicine news :

1. New research confirms efficacy of transcranial magnetic stimulation for depression
2. Transcranial direct current stimulation improves sleep in patients with post-polio syndrome
3. Ancient cranial surgery
4. Study examines benefit of follow-up CT when abdominal ultrasound inconclusive
5. Breast cancer patients with positive ultrasound guided axillary node biopsy need dissection
6. Automated breast ultrasound dramatically reduces physician interpretation time
7. Contrast-enhanced ultrasound monitors aortic aneurysm treatment
8. Huge Rise in CT, MRI, Ultrasound Scan Use: Study
9. AIUM and AUA guideline development leads to practice accreditation for urologic ultrasound
10. AMA adopts diagnostic ultrasound utilization and education resolution
11. FDA OKs First Ultrasound Imaging System for Dense Breasts
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:4/25/2017)... ... ... There is no better place in South Florida to undergo two common ... issue of Consumer Reports focused on heart health. , The magazine gave ... coronary bypass and aortic valve replacement procedures. , Consumer Reports rated Memorial’s ...
(Date:4/24/2017)... ... April 24, 2017 , ... LG CNS ... Own Device (BYOD) capabilities at Telehealth 2.0, the American Telemedicine Association’s national conference. ... pairs medical devices with a pre-programmed tablet in a remarkably easy-to-use kit for ...
(Date:4/24/2017)... ... April 24, 2017 , ... As part of the nationwide Days ... the victims of the Holocaust and Nazi persecution, Center for Medicine after the ... on its CMATH Champions trip to Germany and Poland next week. , The Fourth ...
(Date:4/24/2017)... ... 24, 2017 , ... The California Dental Association Foundation’s two-day volunteer dental clinic, ... people during the April 22-23 event at the San Mateo Event Center. , ... to care, CDA Cares educates the public and policymakers about the importance of good ...
(Date:4/24/2017)... ... April 24, 2017 , ... ALP Nutrition®, a company ... its popular products are now available for purchase on StackedNutrition.com, a popular website ... of premium natural ingredients in making all of its products. These ingredients come ...
Breaking Medicine News(10 mins):
(Date:4/19/2017)... 19, 2017  Sorrento Therapeutics, Inc. (NASDAQ: ... company developing new treatments for cancer and other ... its previously announced underwritten public offering of 23,625,084 ... offering price of $2.00 per share, before deducting ... payable by Sorrento.  The net proceeds to Sorrento ...
(Date:4/19/2017)... , April 19, 2017  SARES•REGIS Group ... it is developing at Conejo Spectrum Business Park ... to Atara Biotherapeutics, Inc. , a biopharmaceutical ... and life-threatening diseases that have been underserved by ... T-cell therapies for cancer, autoimmune and infectious disease. ...
(Date:4/18/2017)... , April 18, 2017 Research and Markets ... 2017-2021" report to their offering. ... The global arthroscopy devices market to grow at a CAGR ... Global Arthroscopy Devices Market 2017-2021, has been prepared based on an ... the market landscape and its growth prospects over the coming years. ...
Breaking Medicine Technology: