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Published on: February 8, 2019
Follow-up vascular ultrasounds in patients with giant cell arteritis
Julia A Ford1, Michael A DiIorio2, Weixing Huang3
1Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, and Harvard Medical School, Boston, MA, USA.
Insights
Follow-up vascular ultrasound (VUS) in giant cell arteritis (GCA) often shows changes, particularly in temporal arteries. Most patients experienced altered VUS interpretations, indicating dynamic disease progression or resolution.
Area of Science:
- Vascular Imaging
- Rheumatology
- Diagnostic Medicine
Background:
- Giant cell arteritis (GCA) diagnosis and monitoring rely on clinical assessment and imaging.
- Vascular ultrasound (VUS) is a key tool, but data on follow-up findings in GCA are limited.
- Understanding VUS changes over time is crucial for effective GCA management.
Purpose of the Study:
- To evaluate changes in vascular ultrasound (VUS) findings during follow-up in patients with giant cell arteritis (GCA).
- To compare the persistence and evolution of VUS abnormalities between different vascular territories.
Main Methods:
- Retrospective analysis of 42 GCA patients with abnormal initial VUS (halo sign or hyperechoic thickening).
- Follow-up VUS interpretations categorized as active arteritis, hyperechoic thickening without active arteritis, or no arteritis.
- Comparison of initial clinical/laboratory data and analysis of VUS interpretation changes using McNemar's test.
Main Results:
- A majority of patients (42/42) showed changes in VUS interpretation between initial and follow-up scans (median 5.1 months apart).
- Among those with active arteritis initially, follow-up VUS revealed active arteritis (25%), hyperechoic thickening (33.3%), or no arteritis (41.7%).
- Sonographic findings were more likely to change in superficial temporal arteries compared to axillary arteries.
Conclusions:
- Follow-up VUS interpretations frequently differ from initial findings in GCA patients.
- Temporal artery involvement in GCA shows more dynamic VUS changes than axillary artery involvement.
Objectives:
Literature describing follow-up vascular ultrasound (VUS) in giant cell arteritis (GCA) is limited. We report our experience with follow-up VUS obtained in clinical care of patients with GCA.
Methods:
We retrospectively identified GCA patients with an abnormal initial VUS, defined as circumferential hypoechoic wall thickening ("halo sign"), or circumferential hyperechoic wall thickening without evidence of arteriosclerosis or arteritis, who subsequently underwent follow-up VUS during 2013-2018. Studies were interpreted as active arteritis, hyperechoic wall thickening without active arteritis, or no arteritis. We compared clinical and laboratory characteristics at time of initial VUS among patients with active arteritis vs. hyperechoic wall thickening without active arteritis. We described whether and how VUS interpretation changed from initial to follow-up VUS. Among individual vessels, we tested whether abnormal findings (e.g. halo sign) persisted at follow-up VUS using McNemar's test.
Results:
42 patients fulfilled study criteria. Median time between initial and follow-up VUS was 5.1 (IQR 2.6-7.9) months. Characteristics at initial VUS did not differ according to VUS interpretation. Among 36 patients with active arteritis on initial VUS, follow-up VUS showed active arteritis in 25.0%, hyperechoic wall thickening in 33.3% and no arteritis in 41.7%. Among 6 patients with hyperechoic wall thickening on initial VUS, half had no arteritis on follow-up VUS. Sonographic findings tended to persist in axillary arteries and were more likely to change in the superficial temporal arteries.
Conclusions:
Among 42 GCA patients, the majority had a change in VUS interpretation between initial and follow-up VUS. Sonographic findings in the temporal circulation more frequently changed than findings in axillary arteries.
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