title: B-mode sonography wall thickness assessment of the temporal and axillary arteries for the diagnosis of giant cell arteritis: a cohort study.
abstract: OBJECTIVE
  We aimed to determine the diagnostic accuracy of B-mode compression sonography of the temporal arteries (tempCS) and B-mode sonographic measurement of the axillary artery intima media thickness (axIMT) for the diagnosis of giant cell arteritis (GCA).
  
  
  METHODS
  After having established measurement of tempCS and axIMT in our routine diagnostic workup, 92 consecutive patients with a suspected diagnosis of GCA were investigated. Clinical characteristics were recorded and wall thickening of the temporal arteries (tempCS) and axillary arteries (axIMT) was measured (mm). Using the final clinical diagnosis as the reference standard, receiver operator characteristics (ROC) analysis was performed. In a subgroup of 26 patients interobserver agreement was assessed using Spearman's rank correlation.
  
  
  RESULTS
  Cranial GCA, extracranial GCA, and combined cranial/extracranial GCA were diagnosed in 18, 7, and 9 individuals, respectively. For the diagnosis of cranial GCA, tempCS had an excellent area under the curve (AUC) of 0.95, with a cut-off of ≥0.7 mm offering a sensitivity and specificity of 85% and 95%. The AUC of axIMT for the diagnosis of extracranial GCA was 0.91 (cut-off ≥1.2 mm: sensitivity and specificity 81.3 and 96.1%). Applying a combined tempCS/axIMT cut-off of ≥0.7mm/1.2 mm, we calculated an overall sensitivity and specificity for the final clinical diagnosis of cranial and/or extracranial GCA of 85.3% and 91.4%. Interobserver agreement was strong for both parameters assessed (Spearman's rho 0.72 and 0.77, respectively).
  
  
  CONCLUSIONS
  The combination of tempCS/axIMT allows objective sonographic assessment in suspected GCA with promising diagnostic accuracy.
authors.affiliation: Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany. michael.czihal@med.uni-muenchen.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Czihal
authors.affiliation: Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Schröttle
authors.affiliation: Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Baustel
authors.affiliation: Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Lottspeich
authors.affiliation: Division of Rheumatology, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Dechant
authors.affiliation: Institute of Clinical Radiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Karla-Maria
authors.initials: KM
authors.lastname: Treitl
authors.affiliation: Institute of Clinical Radiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Treitl
authors.affiliation: Division of Rheumatology, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Schulze-Koops
authors.affiliation: Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001366:Axillary Artery / Q000000981:diagnostic imaging*; D005260:Female; D013700:Giant Cell Arteritis / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color