Novel ultrasonographic Halo Score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia

Kornelis S M van der Geest, Frances Borg, Abdul Kayani, Davy Paap, Prisca Gondo, Wolfgang Schmidt, Raashid Ahmed Luqmani, Bhaskar Dasgupta*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

18 Citations (Scopus)
32 Downloads (Pure)

Abstract

OBJECTIVES: Ultrasound of temporal and axillary arteries may reveal vessel wall inflammation in patients with giant cell arteritis (GCA). We developed a ultrasound scoring system to quantify the extent of vascular inflammation and investigated its diagnostic accuracy and association with clinical factors in GCA.

METHODS: This is a prospective study including 89 patients suspected of having GCA, of whom 58 had a confirmed clinical diagnosis of GCA after 6 months follow-up. All patients underwent bilateral ultrasound examination of the three temporal artery (TA) segments and axillary arteries, prior to TA biopsy. The extent of vascular inflammation was quantified by (1) counting the number of TA segments and axillary arteries with a halo and (2) calculating a composite Halo Score that also incorporated the thickness of each halo.

RESULTS: Halo counts and Halo Scores showed moderate diagnostic accuracy for a clinical diagnosis of GCA. They correlated positively with systemic inflammation. When compared with the halo count, the Halo Score correlated better with C-reactive protein (CRP) levels and allowed to firmly establish the diagnosis of GCA in more patients. Higher halo counts and Halo Scores were associated with a higher risk of ocular ischaemia. They allowed to identify subgroups of patients with low risk (≤5%) and high risk of ocular ischaemia (>30%).

CONCLUSIONS: Ultrasound halo scoring allows to quantify the extent of vascular inflammation in GCA. Extensive vascular inflammation on ultrasound may provide strong diagnostic confirmation and associates with ocular ischaemia in GCA.

Original languageEnglish
Article numbere216343
Pages (from-to)393-399
Number of pages7
JournalAnnals of the Rheumatic Diseases
Volume79
Issue number3
DOIs
Publication statusPublished - Mar-2020

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Axillary Artery/diagnostic imaging
  • Biopsy
  • Eye/blood supply
  • Eye Diseases/diagnostic imaging
  • Female
  • Giant Cell Arteritis/complications
  • Humans
  • Ischemia/diagnostic imaging
  • Male
  • Middle Aged
  • Prospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Temporal Arteries/diagnostic imaging
  • Ultrasonography/methods

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