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Comparison of temporal artery ultrasound versus biopsy in the diagnosis of giant cell arteritis

Eye volume 37, pages 344–349 (2023)Cite this article

Subjects

Abstract

Background/objectives

Giant cell arteritis (GCA) is a medical and ophthalmological emergency due to risk of stroke and sudden irreversible loss of vision. Fast and accurate diagnosis is important to prevent complications and long-term high dose glucocorticoids toxicity. Temporal artery biopsy is gold standard for diagnosing GCA. However, temporal artery ultrasound is a fast and non-invasive procedure which may provide a supplement or an alternative to biopsy. This study assesses the diagnostic performance of ultrasound and biopsy in the diagnosis of GCA.

Subjects/methods

Examination results of patients suspected of having GCA in the period from August 2018 to June 2019 were reviewed. Patients underwent clinical examination and blood tests. Within a few days of starting glucocorticoid treatment, temporal ultrasound and unilateral biopsy were performed. Experienced physicians established the final clinical diagnosis at 6-months follow-up.

Results

Seventy-eight patients underwent both ultrasound and biopsy. Thirty-five (45%) received the final clinical diagnosis of GCA. Compared with the final clinical diagnosis, biopsy had a sensitivity of 69% (51–83%) and a specificity of 100% (92–100%), and ultrasound a sensitivity of 63% (45–79%) and a specificity of 79% (64–94%). Area under the receiver operating characteristics curves were 0.84 and 0.71 for biopsy and ultrasound respectively (p = 0.048). False negative rate of ultrasound was 4 out of 78 (5%).

Conclusion

Sensitivity of ultrasound is almost on par with that of biopsy although the overall diagnostic accuracy of ultrasound was slightly lower. We find that ultrasound is a reliable tool for first line diagnosis of GCA.

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Fig. 1: Temporal artery—common branch. Halo sign: central flow (*) and thickened vessel wall (+).
Fig. 2: Receiver operating characteristic (ROC) curves in diagnosis of giant cell arteritis.

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Funding

The study was funded by Synoptik Foundation and The Danish Rheumatism Association.

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Authors and Affiliations

  1. Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Michael Stormly Hansen, Carsten Faber, Steffen Heegaard, Oliver Niels Klefter, Yousif Subhi, Anne Katrine Wiencke & Steffen Hamann

  2. Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark

    Lene Terslev & Uffe Møller Døhn

  3. Department of Clinical Physiology and Nuclear Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark

    Mads Radmer Jensen

  4. Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Jane Maestri Brittain

  5. Eye Pathology Section, Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Steffen Heegaard & Elisabeth Bay Kønig

Authors
  1. Michael Stormly Hansen
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Contributions

MSH: literature review, drafting of the paper, and data collection. LT: rheumatology expert in GCA and ultrasound; drafting and critical review of the paper. MRJ: expert in GCA and PET; drafting and critical review of the paper. JMB: expert in GCA and PET; drafting and critical review of the paper. UMD: rheumatology Expert in GCA and ultrasound; drafting and critical review of the paper. CF: data collection and review of the paper. SHe: histopathologist; critical review of the paper. ONK: critical review of the paper and statistics. EBK: critical review of the paper. YS: critical review of the paper and statistics. AKW: critical review of the paper. SHa: neuro-ophthalmologist expert in GCA; drafting and critical review of the paper. All authors have read and approved the paper.

Corresponding author

Correspondence to Michael Stormly Hansen.

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The authors declare no competing interests.

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Hansen, M.S., Terslev, L., Jensen, M.R. et al. Comparison of temporal artery ultrasound versus biopsy in the diagnosis of giant cell arteritis. Eye 37, 344–349 (2023). https://doi.org/10.1038/s41433-022-01947-1

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