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