FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 337:1336-1342 November 6, 1997 Number 19 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The diagnosis of temporal arteritis usually requires a biopsy of the temporal artery. We examined the usefulness of color duplex ultrasonography in patients suspected of having temporal arteritis.

Methods In this prospective study, all patients seen in the departments of rheumatology and ophthalmology from January 1994 to October 1996 who had clinically suspected active temporal arteritis or polymyalgia rheumatica were examined by duplex ultrasonography. The final diagnoses, made according to standard criteria, were temporal arteritis in 30 patients, 21 with biopsy-confirmed disease; polymyalgia rheumatica in 37; and negative histologic findings and a diagnosis other than temporal arteritis or polymyalgia rheumatica in 15. We also studied 30 control patients matched for age and sex to the patients with arteritis. Two ultrasound studies were performed and read before the biopsies; one ultrasonographer was unaware of the clinical information.

Results In 22 (73 percent) of the 30 patients with temporal arteritis, ultrasonography showed a dark halo around the lumen of the temporal arteries. The halos disappeared after a mean of 16 days (range, 7 to 56) of treatment with corticosteroids. Twenty-four patients (80 percent) had stenoses or occlusions of temporal-artery segments, and 28 patients (93 percent) had stenoses, occlusions, or a halo. No halos were identified in the 82 patients without temporal arteritis; 6 (7 percent) had stenoses or occlusions. For each of the three types of abnormalities identified by ultrasonography, the interrater agreement was >95 percent.

Conclusions There are characteristic signs of temporal arteritis that can be visualized by color duplex ultrasonography. The most specific sign is a dark halo, which may be due to edema of the artery wall. In patients with typical clinical signs and a halo on ultrasonography, it may be possible to make a diagnosis of temporal arteritis and begin treatment without performing a temporal-artery biopsy.

Source Information

From the Clinic of Rheumatology, Berlin-Buch (W.A.S., E.J.G.-I.), and the Departments of Ophthalmology (H.E.K.), Pathology (K.V.), and Angiology (L.V.), Klinikum Buch — both in Berlin, Germany.

Address reprint requests to Dr. Schmidt at the Clinic of Rheumatology, Zepernicker Strasse 1, 13125 Berlin, Germany.

Full Text of this Article

Related Letters:

Ultrasonography in Temporal Arteritis
Myers K. A., Farquhar D. R.E., Puéchal X., Menkes C.-J., Schmidt W. A., Gromnica-Ihle E. J., Kraft H. E.
Extract | Full Text  
N Engl J Med 1998; 338:760-761, Mar 12, 1998. Correspondence

This article has been cited by other articles:

• Schmidt, W. A., Moll, A., Seifert, A., Schicke, B., Gromnica-Ihle, E., Krause, A. (2008). Prognosis of large-vessel giant cell arteritis. Rheumatology (Oxford) 47: 1406-1408 [Abstract] [Full Text]  
• Gornik, H. L., Creager, M. A. (2008). Aortitis. Circulation 117: 3039-3051 [Full Text]  
• Tato, F., Hoffmann, U. (2008). Giant cell arteritis: a systemic vascular disease. Vasc Med 13: 127-140 [Abstract]  
• Pipitone, N., Versari, A., Salvarani, C. (2008). Role of imaging studies in the diagnosis and follow-up of large-vessel vasculitis: an update. Rheumatology (Oxford) 47: 403-408 [Abstract] [Full Text]  
• Bley, T. A., Markl, M., Schelp, M., Uhl, M., Frydrychowicz, A., Vaith, P., Peter, H.-H., Langer, M., Warnatz, K. (2008). Mural inflammatory hyperenhancement in MRI of giant cell (temporal) arteritis resolves under corticosteroid treatment. Rheumatology (Oxford) 47: 65-67 [Abstract] [Full Text]  
• Schmidt, W. A., Seifert, A., Gromnica-Ihle, E., Krause, A., Natusch, A. (2008). Ultrasound of proximal upper extremity arteries to increase the diagnostic yield in large-vessel giant cell arteritis. Rheumatology (Oxford) 47: 96-101 [Abstract] [Full Text]  
• Alberts, M.S., Mosen, D.M. (2007). Diagnosing temporal arteritis: duplex vs. biopsy. QJM 100: 785-789 [Abstract] [Full Text]  
• Bley, T.A., Uhl, M., Carew, J., Markl, M., Schmidt, D., Peter, H.-H., Langer, M., Wieben, O. (2007). Diagnostic Value of High-Resolution MR Imaging in Giant Cell Arteritis. Am. J. Neuroradiol. 28: 1722-1727 [Abstract] [Full Text]  
• Arnander, M W T, Anderson, N G, Schonauer, F (2006). The ultrasound halo sign in angiolymphoid hyperplasia of the temporal artery.. Br. J. Radiol. 79: e184-e186 [Abstract] [Full Text]  
• Shmerling, R. H. (2006). An 81-year-old woman with temporal arteritis.. JAMA 295: 2525-2534 [Full Text]  
• Schmidt, W A, Wernicke, D, Kiefer, E, Gromnica-Ihle, E (2006). Colour duplex sonography of finger arteries in vasculitis and in systemic sclerosis. Ann Rheum Dis 65: 265-267 [Abstract] [Full Text]  
• Gelsomino, S., Romagnoli, S., Gori, F., Nesi, G., Anichini, C., Sorbara, C., Stefano, P., Gensini, G. F. (2005). Annuloaortic Ectasia and Giant Cell Arteritis. Ann. Thorac. Surg. 80: 101-105 [Abstract] [Full Text]  
• Bley, T. A., Warnatz, K., Wieben, O., Uhl, M., Scholz, C., Vaith, P., Peter, H. H., Langer, M. (2005). High-resolution MRI in giant cell arteritis with multiple inflammatory stenoses in both calves. Rheumatology (Oxford) 44: 954-955 [Full Text]  
• Karassa, F. B., Matsagas, M. I., Schmidt, W. A., Ioannidis, J. P.A. (2005). Meta-Analysis: Test Performance of Ultrasonography for Giant-Cell Arteritis. ANN INTERN MED 142: 359-369 [Abstract] [Full Text]  
• Bley, T. A., Wieben, O., Uhl, M., Thiel, J., Schmidt, D., Langer, M. (2005). High-Resolution MRI in Giant Cell Arteritis: Imaging of the Wall of the Superficial Temporal Artery. Am. J. Roentgenol. 184: 283-287 [Abstract] [Full Text]  
• Brannan, S O, Cheung, D, Murray, P I, Dewar, C, Guest, P (2004). The use of magnetic resonance imaging in the diagnosis of suspected giant cell arteritis. Br. J. Ophthalmol. 88: 1595-1596 [Full Text]  
• Romera-Villegas, A., Vila-Coll, R., Poca-Dias, V., Cairols-Castellote, M. A. (2004). The Role of Color Duplex Sonography in the Diagnosis of Giant Cell Arteritis. J Ultrasound Med 23: 1493-1498 [Abstract] [Full Text]  
• Scheel, A K, Meller, J, Vosshenrich, R, Kohlhoff, E, Siefker, U, Muller, G A, Strutz, F (2004). Diagnosis and follow up of aortitis in the elderly. Ann Rheum Dis 63: 1507-1510 [Abstract] [Full Text]  
• Schmidt, W A, Schmidt, H, Schicke, B, Gromnica-Ihle, E (2004). Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis 63: 988-994 [Abstract] [Full Text]  
• Butteriss, D J A, Clarke, L, Dayan, M, Birchall, D (2004). Use of colour duplex ultrasound to diagnose giant cell arteritis in a case of visual loss of uncertain aetiology. Br. J. Radiol. 77: 607-609 [Abstract] [Full Text]  
• Moosig, F, Czech, N, Mehl, C, Henze, E, Zeuner, R A, Kneba, M, Schroder, J O (2004). Correlation between 18-fluorodeoxyglucose accumulation in large vessels and serological markers of inflammation in polymyalgia rheumatica: a quantitative PET study. Ann Rheum Dis 63: 870-873 [Abstract] [Full Text]  
• Kane, D., Grassi, W., Sturrock, R., Balint, P. V. (2004). Musculoskeletal ultrasound--a state of the art review in rheumatology. Part 2: Clinical indications for musculoskeletal ultrasound in rheumatology. Rheumatology (Oxford) 43: 829-838 [Abstract] [Full Text]  
• Brodmann, M., Lipp, R. W., Passath, A., Seinost, G., Pabst, E., Pilger, E. (2004). The role of 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries. Rheumatology (Oxford) 43: 241-242 [Abstract] [Full Text]  
• Lockhart, M. E., Robbin, M. L. (2003). Case 58: Giant Cell Arteritis. Radiology 227: 512-515 [Full Text]  
• Schmidt, W. A., Gromnica-Ihle, E. (2003). Duplex Ultrasonography in Temporal Arteritis. ANN INTERN MED 138: 609-609 [Full Text]  
• Mourad, O., Palda, V., Detsky, A. S. (2003). A Comprehensive Evidence-Based Approach to Fever of Unknown Origin. Arch Intern Med 163: 545-551 [Abstract] [Full Text]  
• Reitblat, T, Ben-Horin, C L, Reitblat, A (2003). Gallium-67 SPECT scintigraphy may be useful in diagnosis of temporal arteritis. Ann Rheum Dis 62: 257-260 [Abstract] [Full Text]  
• Hui, A.C.F., Wong, S.M., Griffith, J.F., Lai, F., Li, E. (2003). Sonographic demonstration of temporal arteritis. Neurology 60: 347-348 [Full Text]  
• Salvarani, C., Silingardi, M., Ghirarduzzi, A., Lo Scocco, G., Macchioni, P., Bajocchi, G., Vinceti, M., Cantini, F., Iori, I., Boiardi, L. (2002). Is Duplex Ultrasonography Useful for the Diagnosis of Giant-Cell Arteritis?. ANN INTERN MED 137: 232-238 [Abstract] [Full Text]  
• Salvarani, C., Cantini, F., Boiardi, L., Hunder, G. G. (2002). Polymyalgia Rheumatica and Giant-Cell Arteritis. NEJM 347: 261-271 [Full Text]  
• Docken, W. P., Mark, E. J. (2002). Case 23-2002 - A 73-Year-Old Man with Leg Pains, Occipital Headaches, and Night Sweats. NEJM 347: 272-278 [Full Text]  
• Hellmann, D. B. (2002). Temporal Arteritis: A Cough, Toothache, and Tongue Infarction. JAMA 287: 2996-3000 [Abstract] [Full Text]  
• Schmidt, W. A., Nerenheim, A., Seipelt, E., Poehls, C., Gromnica-Ihle, E. (2002). Diagnosis of early Takayasu arteritis with sonography. Rheumatology (Oxford) 41: 496-502 [Abstract] [Full Text]  
• Nesi, G., Anichini, C., Pedemonte, E., Tozzini, S., Calamai, G., Montesi, G. F., Gori, F. (2002). Giant Cell Arteritis Presenting With Annuloaortic Ectasia*. Chest 121: 1365-1367 [Abstract] [Full Text]  
• Schmidt, W. A., Gromnica-Ihle, E. (2002). Incidence of temporal arteritis in patients with polymyalgia rheumatica: a prospective study using colour Doppler ultrasonography of the temporal arteries. Rheumatology (Oxford) 41: 46-52 [Abstract] [Full Text]  
• Roters, S., Szurman, P., Engels, B. F, Brunner, R. (2001). The suitability of the ultrasound biomicroscope for establishing texture in giant cell arteritis. Br. J. Ophthalmol. 85: 946-948 [Abstract] [Full Text]  
• KILLER, H E, HOLTZ, D J, KAISER, H J, LAENG, R H (2000). Diplopia, ptosis, and hepatitis as presenting signs and symptoms of giant cell arteritis. Br. J. Ophthalmol. 84: 1318b-1318 [Full Text]  
• Genereau, T., Lortholary, O., Guillevin, L., Cacoub, P., Galezowski, N., Cherin, P., Babinet, P., Herreman, G., Wechsler, B., Cohen, P., Herson, S., Caillat-Vigneron, N. (1999). Temporal 67gallium uptake is increased in temporal arteritis. Rheumatology (Oxford) 38: 709-713 [Abstract] [Full Text]  
• Botella-Estrada, R., Sammartin, O., Martinez, V., Campos, S., Aliaga, A. (1999). Magnetic Resonance Angiography in the Diagnosis of a Case of Giant Cell Arteritis Manifesting as Scalp Necrosis. Arch Dermatol 135: 769-771 [Full Text]  
• Gordon, L. K., Levin, L. A. (1998). Visual Loss in Giant Cell Arteritis. JAMA 280: 385-386 [Full Text]  
• Myers, K. A., Farquhar, D. R.E., Puechal, X., Menkes, C.-J., Schmidt, W. A., Gromnica-Ihle, E. J., Kraft, H. E. (1998). Ultrasonography in Temporal Arteritis. NEJM 338: 760-761 [Full Text]  
• (1997). ULTRASONOGRAPHY FOR TEMPORAL ARTERITIS. JWatch General 1997: 2-2 [Full Text]  
• Hunder, G. G., Weyand, C. M. (1997). Sonography in Giant-Cell Arteritis. NEJM 337: 1384-1386 [Full Text]