PT  - JOURNAL ARTICLE
AU  - Kornelis S M van der Geest
AU  - Frances Borg
AU  - Abdul Kayani
AU  - Davy Paap
AU  - Prisca Gondo
AU  - Wolfgang Schmidt
AU  - Raashid Ahmed Luqmani
AU  - Bhaskar Dasgupta
TI  - Novel ultrasonographic Halo Score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia
AID  - 10.1136/annrheumdis-2019-216343
DP  - 2020 Mar 01
TA  - Annals of the Rheumatic Diseases
PG  - 393--399
VI  - 79
IP  - 3
4099  - http://ard.bmj.com/content/79/3/393.short
4100  - http://ard.bmj.com/content/79/3/393.full
SO  - Ann Rheum Dis2020 Mar 01; 79
AB  - Objectives Ultrasound of temporal and axillary arteries may reveal vessel wall inflammation in patients with giant cell arteritis (GCA). We developed a ultrasound scoring system to quantify the extent of vascular inflammation and investigated its diagnostic accuracy and association with clinical factors in GCA.Methods This is a prospective study including 89 patients suspected of having GCA, of whom 58 had a confirmed clinical diagnosis of GCA after 6 months follow-up. All patients underwent bilateral ultrasound examination of the three temporal artery (TA) segments and axillary arteries, prior to TA biopsy. The extent of vascular inflammation was quantified by (1) counting the number of TA segments and axillary arteries with a halo and (2) calculating a composite Halo Score that also incorporated the thickness of each halo.Results Halo counts and Halo Scores showed moderate diagnostic accuracy for a clinical diagnosis of GCA. They correlated positively with systemic inflammation. When compared with the halo count, the Halo Score correlated better with C-reactive protein (CRP) levels and allowed to firmly establish the diagnosis of GCA in more patients. Higher halo counts and Halo Scores were associated with a higher risk of ocular ischaemia. They allowed to identify subgroups of patients with low risk (≤5%) and high risk of ocular ischaemia (>30%).Conclusions Ultrasound halo scoring allows to quantify the extent of vascular inflammation in GCA. Extensive vascular inflammation on ultrasound may provide strong diagnostic confirmation and associates with ocular ischaemia in GCA.