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

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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

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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

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