ObjectivesThis study aims to establish the sensitivity and negative predictive value of a multimodal pathway incorporating ultrasonography, 18-fluorodeoxyglucose labelled PET-CT and temporal artery biopsy for the diagnosis of giant cell arteritis.MethodsIn total, 1000 consecutive referrals for a new diagnosis of giant cell arteritis were analysed. All patients had a protocolized examination. Patients with a negative ultrasonography and a CRP of ≥20 mg/L received an extended ultrasound examination. If that was negative, and there was no other explanation for their presentation, a second test in the form of either a temporal artery biopsy or an 18-fluorodeoxyglucose labelled PET-CT was offered. We calculated the sensitivity and negative predictive value of the interventions for diagnosing giant cell arteritis.Results279/1000 patients had positive ultrasonography for giant cell arteritis. 202 had bilateral superficial temporal arterial involvement. Ultrasonography of the axillary artery and other head/neck arteries increased the yield by 53 and 24 patients, respectively. 181 patients were referred for a second test. 24/139 temporal artery biopsies and 7/42 18-fluorodeoxyglucose labelled PET-CT scans were positive. The sensitivity and negative predictive value rise from 62.3% and 84.7%, respectively, for imaging superficial temporal arteries alone, to 95.7% and 98.0%, respectively, for extended ultrasonography plus a second test.ConclusionThis is the first real-world evidence of the utility of ultrasonography for the diagnosis of giant cell arteritis as part of a multimodal diagnostic pathway.

中文翻译：

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超声引导下治疗巨细胞动脉炎的多模式诊断途径


目的本研究旨在确定结合超声检查、18-氟脱氧葡萄糖标记的 PET-CT 和颞动脉活检诊断巨细胞动脉炎的多模式途径的敏感性和阴性预测价值。方法总共分析了 1000 例连续转诊的新诊断为巨细胞动脉炎。所有患者均进行了方案化检查。超声检查阴性且 CRP 为 ≥20 mg/L 的患者接受了扩展超声检查。如果结果是否定的，并且没有其他解释，则提供颞动脉活检或 18-氟脱氧葡萄糖标记 PET-CT 形式的第二次测试。我们计算了干预措施诊断巨细胞动脉炎的敏感性和阴性预测价值。结果279/1000 例患者的巨细胞动脉炎超声检查阳性。202 例有双侧颞浅动脉受累。腋动脉和其他头/颈动脉的超声检查分别增加了 53 例和 24 例患者的检出率。181 名患者被转诊进行第二次测试。24/139 例颞动脉活检和 7/42 例 18-氟脱氧葡萄糖标记的 PET-CT 扫描呈阳性。敏感性和阴性预测值分别从单独对颞浅动脉成像的 62.3% 和 84.7% 上升到扩展超声检查加第二次测试的 95.7% 和 98.0%。结论这是超声检查作为多模式诊断途径的一部分用于诊断巨细胞动脉炎的第一个真实世界证据。