Color Duplex Ultrasonography in the Diagnosis of Temporal Arteritis

Schmidt, Kraft, Vorphal, Volker, Gromnica-Ihle

NEJM, Nov. 6, 1997, 1336

Clinical Bottom Lines

1. In a real clinical situation, deciding to commit an older patient (particularly a woman) to a protracted course of even low dose prednisone for presumed Temporal Arteritis has required at least an attempt to prove the diagnosis with a biopsy. A positive finding on a non-invasive study like Color Duplex Ultrasound might be enough without subjecting the patient to the morbidity of a surgical procedure.

2. A negative Color Duplex study in a patient of the right age would not remove Temporal Arteritis from my thinking - the potential morbidity without treatment is too high.

3 This technique needs to be studied in a more non-selected population.

The Study

• Prospective trial taking all patients seen January 1994 through October 1996 in "the departments of rheumatology and ophthalmology" in Berlin, Germany.
• Pathologists interpreting the biopsies were not necessarily blinded to the results of the ultrasounds.
• 112 patients underwent ultrasonography (30 clinically having TA, 37 having PMR, 30 controls selected from clinic patients with RA, and 15 patients with "other" diagnoses). Forty-seven underwent biopsy (27 clinically having TA, 7 clinically having PMR, and 15 having "other" diagnoses).
• Twenty-five of the TA patients had received some corticosteroid prior to the study (10 patients for less than 24 hours, 11 patients for 1 to 10 days, and 4 patients treated with doses said to be "too low"). Twenty-three of the PMR patients had had some corticosteroid prior to the study (7 patients for less than 24 hours, 16 patients for 1 to 10 days). Fifteen of the control patients received corticosteroids prior to the study. Four of the "other diagnoses" patients received steroids prior to the study.
• Two ultrasonographers read the duplex scans separately and had 95% (combined) concordance. All ultrasounds were done prior to biopsy.

Results