title: Limited value of temporal artery ultrasonography examinations for diagnosis of giant cell arteritis: analysis of 77 subjects.
abstract: OBJECTIVE
  Use of TA-US for diagnostic investigation of giant cell arteritis (GCA) has been proposed but remains a matter of debate because of the heterogeneous findings. We retrospectively evaluated operating characteristics of temporal artery ultrasonography (TA-US) in a single teaching hospital.
  
  
  METHODS
  All subjects with suspected GCA had been seen between 2002 and 2008 and had undergone TA-US with continuous-wave Doppler (until 2004) or color duplex ultrasonography (after 2004), followed within 30 days by a temporal artery biopsy (TAB). TA-US findings were compared with TAB-proven GCA and clinically diagnosed GCA. Results are expressed as sensitivities, specificities, and positive (LR+) and negative likelihood ratios (LR-) of stenoses, occlusions, and the halo sign; for the latter, only color duplex TA-US was considered.
  
  
  RESULTS
  Seventy-seven patients fulfilled the selection criteria; 13 had TAB-proven and 19 had clinically defined GCA. Stenoses/occlusions were seen on 45.5% of TA-US and the halo sign was seen only once (3.2%) in 31 duplex TA-US. Respective sensitivities, specificities, LR+, and LR- for GCA diagnosis (using TAB-proven/clinically defined GCA as reference standards) were 69%/53%, 59%/57%, 1.7/1.2, and 0.5/0.8 for stenoses and/or occlusions, and 17%/10%, 100%/100%, infinite/infinite, and 0.8/0.9 for the halo sign.
  
  
  CONCLUSIONS
  The halo sign showed 100% specificity for GCA but only 10%-17% sensitivity. Stenoses/occlusions were of low diagnostic value. These observations suggest that TA-US is neither an effective substitute for TAB nor a reliable screening test to decide which patients can be safely spared TAB.
authors.affiliation: National Referral Center for Necrotizing Vasculitides and Systemic Sclerosis, Hospital Cochin, Assistance Publique-Hôpitaux de Paris, University Paris 5-René Descartes, Paris, France.
authors.forename: Carla
authors.initials: C
authors.lastname: Maldini
authors.forename: Caroline
authors.initials: C
authors.lastname: Dépinay-Dhellemmes
authors.forename: Thi T S
authors.initials: TT
authors.lastname: Tra
authors.forename: Michel
authors.initials: M
authors.lastname: Chauveau
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Geneviève
authors.initials: G
authors.lastname: Terrasse
authors.forename: Loïc
authors.initials: L
authors.lastname: Guillevin
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Alfred
authors.initials: A
authors.lastname: Mahr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013700:Giant Cell Arteritis / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013699:Temporal Arteries / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color