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The Predictive Value of the Halo Sign in Color Doppler Ultrasonography of the Temporal Arteries for Diagnosing Giant Cell Arteritis
GIDEON NESHER, DAVID SHEMESH, MICHAL MATES, MOSHE SONNENBLICK, and HARRY B. ABRAMOWITZ
ABSTRACT.
Methods. During a period of 2 years 69 patients suspected of having GCA were examined by US of both temporal arteries. Temporal artery biopsy was performed in 32 of these patients. The diagnosis of GCA was made if a patient had a biopsy showing arteritis, or met all the following criteria: (1) American College of Rheumatology GCA classification criteria were fulfilled; (2) there was a prompt clinical response to treatment with 40-60 mg/day of prednisone; and (3) no other diagnosis related to the patient's symptoms was made during 6 month followup. Results. Periluminal dark halo was observed in 24 of 69 patients. GCA was diagnosed in 12 of them, giving a positive predictive value (PPV) of only 50%. No halo was detected in 45 cases of which only 2 had GCA, resulting in a high negative predictive value (NPV) of 96%. The sensitivity and specificity of the halo sign for diagnosing GCA were 86% and 78%, respectively. Conclusion. The PPV of the halo sign in US of the temporal arteries is unsatisfactory for diagnosing GCA. However, the NPV is very high. Thus the lack of a halo can practically serve to rule out a diagnosis of GCA, and precludes the need for a biopsy in most instances. (J Rheumatol 2002;29:1224-6) Key Indexing Terms:
TEMPORAL ARTERITIS
From the Department of Internal Medicine, Rheumatology Service, Department of Surgery B and Vascular Surgery Unit; and Department of Geriatric Medicine, Shaare-Zedek Medical Center, Jerusalem, Israel. G. Nesher, MD, Clinical Associate Professor of Medicine, the Hebrew University Medical School, Director, Rheumatology Service, Shaare-Zedek Medical Center; D. Shemesh, MD, RVT, Staff Physician, Department of Surgery B and the Vascular Unit; M. Mates, MD, Staff Physician, Rheumatology Service; M. Sonnenblick, MD, Clinical Associate Professor of Medicine, the Hebrew University Medical School, Director, Department of Geriatric Medicine; H.B. Abramowitz, MD, FACS, Director, Department of Surgery B, and Director, Peripheral Vascular Laboratory, Shaare-Zedek Medical Center. Address reprint requests to Dr. G. Nesher, Department of Internal Medicine, Shaare-Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel. Submitted July 30, 2001; revision accepted December 29, 2001. |