Wa. Schmidt et al., COLOR DUPLEX ULTRASONOGRAPHY IN THE DIAGNOSIS OF TEMPORAL ARTERITIS, The New England journal of medicine, 337(19), 1997, pp. 1336-1342
Background The diagnosis of temporal arteritis usually requires a biop
sy of the temporal artery. We examined the usefulness of color duplex
ultrasonography in patients suspected of having temporal arteritis. Me
thods In this prospective study, all patients seen in the departments
of rheumatology and ophthalmology from January 1994 to October 1996 wh
o had clinically suspected active temporal arteritis or polymyalgia rh
eumatica were examined by duplex ultrasonography. The final diagnoses,
made according to standard criteria, were temporal arteritis in 30 pa
tients, 21 with biopsy-confirmed disease; polymyalgia rheumatica in 37
; and negative histologic findings and a diagnosis other than temporal
arteritis or polymyalgia rheumatica in 15. We also studied 30 control
patients matched for age and sex to the patients with arteritis. Two
ultrasound studies were performed and read before the biopsies; one ul
trasonographer was unaware of the clinical information. Results In 22
(73 percent) of the 30 patients with temporal arteritis, ultrasonograp
hy showed a dark halo around the lumen of the temporal arteries. The h
alos disappeared after a mean of 16 days (range, 7 to 56) of treatment
with corticosteroids. Twenty four patients (80 percent) had stenoses
or occlusions of temporal-artery segments, and 28 patients (93 per cen
t) had stenoses, occlusions, or a halo. No halos were identified in th
e 82 patients without temporal arteritis; 6 (7 percent) had stenoses o
r occlusions. For each of the three types of abnormalities identified
by ultrasonography, the interrater agreement was greater than or equal
to 95 percent. Conclusions There are characteristic signs of temporal
arteritis that can be visualized by color duplex ultrasonography. The
most specific sign is a dark halo, which may be due to edema of the a
rtery wall. In patients with typical clinical signs and a halo on ultr
asonography, it may be possible to make a diagnosis of temporal arteri
tis and begin treatment without performing a temporal-artery biopsy. (
C) 1997, Massachusetts Medical Society.