Featured Research

from universities, journals, and other organizations

Cranial ultrasound may replace temporal artery biopsy in diagnosis of giant cell arteritis

Date:
June 12, 2014
Source:
European League Against Rheumatism
Summary:
A new study shows that cranial ultrasound has a greater sensitivity than temporal artery biopsy, and a comparable specificity in the diagnosis of Giant Cell Arteritis.

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).

Related Articles


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%. 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. 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.

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.


Story Source:

The above story is based on materials provided by European League Against Rheumatism. Note: Materials may be edited for content and length.


Cite This Page:

European League Against Rheumatism. "Cranial ultrasound may replace temporal artery biopsy in diagnosis of giant cell arteritis." ScienceDaily. ScienceDaily, 12 June 2014. <www.sciencedaily.com/releases/2014/06/140612085351.htm>.
European League Against Rheumatism. (2014, June 12). Cranial ultrasound may replace temporal artery biopsy in diagnosis of giant cell arteritis. ScienceDaily. Retrieved October 24, 2014 from www.sciencedaily.com/releases/2014/06/140612085351.htm
European League Against Rheumatism. "Cranial ultrasound may replace temporal artery biopsy in diagnosis of giant cell arteritis." ScienceDaily. www.sciencedaily.com/releases/2014/06/140612085351.htm (accessed October 24, 2014).

Share This



More Health & Medicine News

Friday, October 24, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

IKEA Desk Converts From Standing to Sitting With One Button

IKEA Desk Converts From Standing to Sitting With One Button

Buzz60 (Oct. 24, 2014) IKEA is out with a new convertible desk that can convert from a sitting desk to a standing one with just the push of a button. Jen Markham explains. Video provided by Buzz60
Powered by NewsLook.com
Ebola Protective Suits Being Made in China

Ebola Protective Suits Being Made in China

AFP (Oct. 24, 2014) A factory in China is busy making Ebola protective suits for healthcare workers and others fighting the spread of the virus. Duration: 00:38 Video provided by AFP
Powered by NewsLook.com
WHO: Millions of Ebola Vaccine Doses by 2015

WHO: Millions of Ebola Vaccine Doses by 2015

AP (Oct. 24, 2014) The World Health Organization said on Friday that millions of doses of two experimental Ebola vaccines could be ready for use in 2015 and five more experimental vaccines would start being tested in March. (Oct. 24) Video provided by AP
Powered by NewsLook.com
Doctor in NYC Quarantined With Ebola

Doctor in NYC Quarantined With Ebola

AP (Oct. 24, 2014) An emergency room doctor who recently returned to the city after treating Ebola patients in West Africa has tested positive for the virus. He's quarantined in a hospital. (Oct. 24) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins