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Meta-analysis: test performance of ultrasonography for giant-cell arteritis
Fotini B Karassa1, Miltiadis I Matsagas, Wolfgang A Schmidt
1University of Ioannina School of Medicine and Foundation for Research and Technology-Hellas, Ioannina, Greece.
Insights
Ultrasonography shows promise for diagnosing giant-cell arteritis (GCA). Negative ultrasound results can help exclude GCA when clinical suspicion is low.
Area of Science:
- Rheumatology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Giant-cell arteritis (GCA) presents diagnostic challenges.
- Accurate diagnosis is crucial for timely treatment and preventing complications.
Purpose of the Study:
- To evaluate the diagnostic performance of ultrasonography for GCA.
- To synthesize evidence from existing studies on temporal artery ultrasonography in GCA diagnosis.
Main Methods:
- Systematic review and meta-analysis of studies up to April 2004.
- Included studies used temporal artery ultrasonography and biopsy or American College of Rheumatology (ACR) criteria as reference standards.
- Data on sensitivity and specificity were extracted and analyzed.
Main Results:
- Twenty-three studies with 2036 patients were included.
- The halo sign showed a sensitivity of 69% and specificity of 82% versus biopsy.
- Stenosis or occlusion also demonstrated significant sensitivity (68% vs. biopsy).
- Negative ultrasound results effectively excluded GCA when pretest probability was 10%.
Conclusions:
- Ultrasonography is a potentially valuable tool for diagnosing GCA.
- Study quality and heterogeneity were noted limitations.
- Interpretation requires careful consideration of clinical context and pretest probability.
Background:
Giant-cell arteritis is a diagnostic challenge.
Purpose:
To determine the diagnostic performance of ultrasonography for giant-cell arteritis.
Data Sources:
Studies published up to April 2004 in the MEDLINE, EMBASE, and Cochrane databases; reference lists; and direct contact with investigators.
Study Selection:
Studies in any language that examined temporal artery ultrasonography for diagnosis of giant-cell arteritis, enrolled at least 5 patients, and used biopsy or the American College of Rheumatology (ACR) criteria as the reference standard.
Data Extraction:
Two reviewers independently graded methodologic quality and abstracted data on sensitivity and specificity of ultrasonography for giant-cell arteritis. Diagnostic performance was determined for the halo sign, stenosis, or occlusion and for any of these ultrasonographic abnormalities.
Data Synthesis:
Weighted sensitivity and specificity estimates and summary receiver-operating characteristic (ROC) curve analysis were used. Twenty-three studies, involving a total of 2036 patients, met the inclusion criteria. The weighted sensitivity and specificity of the halo sign were 69% (95% CI, 57% to 79%) and 82% (CI, 75% to 87%), respectively, compared with biopsy and 55% (CI, 36% to 73%) and 94% (CI, 82% to 98%), respectively, compared with ACR criteria. Stenosis or occlusion was an almost equally sensitive marker compared with either biopsy (sensitivity, 68% [CI, 49% to 82%]) or ACR criteria (sensitivity, 66% [CI, 32% to 89%]). Consideration of any vessel abnormality nonsignificantly improved diagnostic performance compared with ACR criteria. Between-study heterogeneity was significant, but summary ROC curves were consistent with weighted estimates. When the pretest probability of giant-cell arteritis is 10%, negative results on ultrasonography practically exclude the disease (post-test probability, 2% to 5% for various analyses).
Limitations:
The primary studies were small and of modest quality and had considerable heterogeneity.
Conclusion:
Ultrasonography may be helpful in diagnosing giant-cell arteritis, but cautious interpretation of the test results based on clinical presentation and pretest probability of the disease is imperative.
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