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DOI: 10.1055/a-0956-6671
Die Duplexsonografie in der Diagnostik der Riesenzellarteriitis
Duplex Sonography in Giant-cell ArteritisPublication History
Publication Date:
16 July 2019 (online)
![](https://www.thieme-connect.de/media/rheuma/201904/lookinside/thumbnails/2019-04-0565_10-1055-a-0956-6671-1.jpg)
Zusammenfassung
Aufgrund ihrer hohen Inzidenz und des hohen Risikos für Erblindung und Apoplexie muss die Diagnose einer Riesenzellarteriitis rasch gestellt werden. Bei entsprechender klinischer Konstellation mit temporalen Kopfschmerzen, Kauclaudicatio, plötzlichem Visusverlust, Polymyalgia-rheumatica-Symptomatik und konstitutionellen Symptomen ist es mithilfe der Duplexsonografie in der Regel möglich, die Erkrankung zu diagnostizieren. Typische sonografische Befunde als Ausdruck der Gefäßwandinflammation sind echoarme Intima-Media-Verdickungen, Haloformationen, ein positives Kompressionszeichen sowie Stenosen und Vasookklusionen. Dabei kann die Duplexsonografie in geübten Händen hinsichtlich Sensitivität und Spezifität problemlos mit der Temporalisbiopsie, PET/CT und MRT konkurrieren. Mit der vorliegenden Arbeit möchten wir die aktuelle Datenlage zur Duplexsonografie darlegen und praktische Hinweise für die Anwendung im Alltag liefern.
Abstract
Due to its high incidence and its high risk for blindness and stroke, giant-cell arteritis must be diagnosed quickly. In the context of typical clinical features such as temporal headaches, jaw claudication, acute onset of loss of vision, polymyalgia rheumatica and constitutional symptoms, the diagnosis can be made by duplex sonography. Typical sonographic findings pointing to vessel wall inflammation include hypoechoic thickening of the intima-media complex, halo formation, a positive compression sign, stenosis and vessel occlusion. In the hands of a well-trained sonographer, duplex sonography can easily compete with temporal artery biopsy, PET/CT and MRI in terms of sensitivity and specificity. In the following article, we have summarised the current data available on duplex sonography and provided practical hints for everyday application.
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Literatur
- 1 Mukhtyar C, Guillevin L, Cid MC. et al. European Vasculitis Study Group EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2009; 68: 318-323
- 2 Dejaco C, Ramiro S, Duftner C. et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018; 77: 636-643
- 3 Luqmani R, Lee E, Singh S. et al. The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study. Health Technol Assess 2016; 20: 1-238
- 4 Terslev L, Hammer H, Torp-Pedersen S. et al. EFSUMB Minimum Training Requirements for Rheumatologists Performing Musculoskeletal Ultrasound. Ultraschall der Medizin – Eur J Ultrasound 2013; 34: e11-e11
- 5 Pfadenhauer K, Weber H. Duplex sonography of the temporal and occipital artery in the diagnosis of temporal arteritis. A prospective study. J Rheumatol 2003; 30: 2177-2181
- 6 Ješe R, Rotar Ž, Tomšič M. et al. The role of colour doppler ultrasonography of facial and occipital arteries in patients with giant cell arteritis: A prospective study. Eur J Radiol 2017; 95: 9-12
- 7 Förster S, Tato F, Weiss M. et al. Patterns of extracranial involvement in newly diagnosed giant cell arteritis assessed by physical examination, colour coded duplex sonography and FDG-PET. Vasa 2011; 40: 219-227
- 8 Löffler C, Hoffend J, Benck U. et al. The value of ultrasound in diagnosing extracranial large-vessel vasculitis compared to FDG-PET/CT: A retrospective study. Clin Rheumatol 2017; 36: 2079-2086
- 9 Schmidt WA, Seifert A, Gromnica-Ihle E. et al. Ultrasound of proximal upper extremity arteries to increase the diagnostic yield in large-vessel giant cell arteritis. Rheumatology 2008; 47: 96-101
- 10 Wilkinson IM, Russell RW. Arteries of the head and neck in giant cell arteritis. A pathological study to show the pattern of arterial involvement. Arch Neurol 1972; 27: 378-391
- 11 Löffler C, Hoffend J, Rebel M. et al. A rare cause for lower back pain: a case of an IgG4-related periaortitis. Clin Rheumatol 2016; 35: 265-270
- 12 Aschwanden M, Daikeler T, Kesten F. et al. Temporal artery compression sign – a novel ultrasound finding for the diagnosis of giant cell arteritis. Ultraschall Med 2013; 34: 47-50
- 13 Aschwanden M, Imfeld S, Staub D et al. The ultrasound compression sign to diagnose temporal giant cell arteritis shows an excellent interobserver agreement. Clin Exp Rheumatol 33: S-113-5
- 14 Chrysidis S, Duftner C, Dejaco C. et al. Definitions and reliability assessment of elementary ultrasound lesions in giant cell arteritis: A study from the OMERACT large vessel vasculitis ultrasound working group. RMD Open. 2018. 17 e000598
- 15 Schmidt WA, Kraft HE, Völker L. et al. Colour Doppler sonography to diagnose temporal arteritis. Lancet (London, England) 1995; 345: 866
- 16 Salvarani C, Silingardi M, Ghirarduzzi A. et al. Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis?. Ann Intern Med 2002; 137: 232-238
- 17 Karassa FB, Matsagas MI, Schmidt WA. et al. Meta-analysis: test performance of ultrasonography for giant-cell arteritis. Ann Intern Med 2005; 142: 359-369
- 18 Arida A, Kyprianou M, Kanakis M. et al. The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskelet Disord 2010; 11: 44
- 19 Maldini C, Dépinay-Dhellemmes C, Tra TTS. et al. Limited value of temporal artery ultrasonography examinations for diagnosis of giant cell arteritis: analysis of 77 subjects. J Rheumatol 2010; 37: 2326-2330
- 20 Aranda-Valera IC, García Carazo S, Monjo Henry I. et al. Diagnostic validity of Doppler ultrasound in giant cell arteritis. Clin Exp Rheumatol 2017; 35 Suppl 103 123-127
- 21 Duftner C, Dejaco C, Sepriano A. et al. Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and meta-analysis informing the EULAR recommendations. RMD open 2018; 4: e000612
- 22 Schäfer VS, Juche A, Ramiro S. et al. Ultrasound cut-off values for intima-media thickness of temporal, facial and axillary arteries in giant cell arteritis. Rheumatol (United Kingdom) 2017; 56: 1479-1483
- 23 Czihal M, Schröttle A, Baustel K. et al. B-mode sonography wall thickness assessment of the temporal and axillary arteries for the diagnosis of giant cell arteritis: a cohort study. Clin Exp Rheumatol 2017; 35 Suppl 103 128-133
- 24 Stanson AW. Imaging findings in extracranial (giant cell) temporal arteritis. Clin Exp Rheumatol 18: S43-S48
- 25 Assie C, Janvresse A, Plissonnier D. et al. Long-term follow-up of upper and lower extremity vasculitis related to giant cell arteritis: a series of 36 patients. Medicine (Baltimore) 2011; 90: 40-51
- 26 Robson JC, Kiran A, Maskell J. et al. The relative risk of aortic aneurysm in patients with giant cell arteritis compared with the general population of the UK. Ann Rheum Dis 2015; 74: 129-135
- 27 Muratore F, Kermani TA, Crowson CS. et al. Large-Vessel Dilatation in Giant Cell Arteritis: A Different Subset of Disease?. Arthritis Care Res 2018; 70: 1406-1411
- 28 Mackie SL, Hensor EMA, Morgan AW. et al. Should I send my patient with previous giant cell arteritis for imaging of the thoracic aorta? A systematic literature review and meta-analysis. Ann Rheum Dis 2014; 73: 143-148
- 29 García-Martínez A, Arguis P, Prieto-González S. et al. Prospective long term follow-up of a cohort of patients with giant cell arteritis screened for aortic structural damage (aneurysm or dilatation). Ann Rheum Dis 2014; 73: 1826-1832
- 30 Monti S, Floris A, Ponte CB. et al. The proposed role of ultrasound in the management of giant cell arteritis in routine clinical practice. Rheumatology 2018; 57: 112-119
- 31 Hauenstein C, Reinhard M, Geiger J. et al. Effects of early corticosteroid treatment on magnetic resonance imaging and ultrasonography findings in giant cell arteritis. Rheumatology 2012; 51: 1999-2003
- 32 Patil P, Williams M, Maw WW et al. Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study. Clin Exp Rheumatol 2015; 33: S-103-6
- 33 Karassa F, Matsagas M, Schmidt W et al. Review Meta-Analysis : Test Performance of Ultrasonography for. Ann Intern Med 2005
- 34 Pfenninger L, Horst A, Stuckmann G. et al. Comparison of histopathological findings with duplex sonography of the temporal arteries in suspected giant cell arteritis. Klin Monbl Augenheilkd 2012; 229: 369-373
- 35 Karahaliou M, Vaiopoulos G, Papaspyrou S. et al. Colour duplex sonography of temporal arteries before decision for biopsy: A prospective study in 55 patients with suspected giant cell arteritis. Arthritis Res Ther 2006; 8: 1-8
- 36 Germanò G, Muratore F, Cimino L. et al. Is colour duplex sonography-guided temporal artery biopsy useful in the diagnosis of giant cell arteritis? A randomized study. Rheumatology (Oxford) 2015; 54: 400-404
- 37 Muratore F, Boiardi L, Restuccia G. et al. Comparison between colour duplex sonography findings and different histological patterns of temporal artery. Rheumatology (Oxford) 2013; 52: 2268-2274
- 38 Restuccia G, Cavazza A, Boiardi L. et al. Small-vessel vasculitis surrounding an uninflamed temporal artery and isolated vasa vasorum vasculitis of the temporal artery: Two subsets of giant cell arteritis. Arthritis Rheum 2012; 64: 549-556
- 39 Hunder GG. Giant Cell (Temporal) Arteritis. Rheum Dis Clin North Am 1990; 16: 399-409
- 40 Henes JC, Müller M, Krieger J. et al. [18F] FDG-PET/CT as a new and sensitive imaging method for the diagnosis of large vessel vasculitis. Clin Exp Rheumatol 2008; 26: S47-S52
- 41 Brodmann M, Lipp RW, Passath A. et al. 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 2004; 43: 241-242
- 42 Pfadenhauer K, Weinerth J, Hrdina C. Vertebral arteries: a target for FDG-PET imaging in giant cell arteritis? Clinical, ultrasonographic and PET study in 46 patients. Nuklearmedizin 2011; 50: 28-32
- 43 Bley TA, Reinhard M, Hauenstein C. et al. Comparison of duplex sonography and high-resolution magnetic resonance imaging in the diagnosis of giant cell (temporal) arteritis. Arthritis Rheum 2008; 58: 2574-2578
- 44 Czihal M, Piller A, Schroettle A. et al. Impact of cranial and axillary/subclavian artery involvement by color duplex sonography on response to treatment in giant cell arteritis. J Vasc Surg 2015; 61: 1285-1291
- 45 Muratore F, Pipitone N, Salvarani C. et al. Imaging of vasculitis: State of the art. Best Pract Res Clin Rheumatol 2016; 30: 688-706
- 46 Germanò G, Macchioni P, Possemato N. et al. Contrast-Enhanced Ultrasound of the Carotid Artery in Patients With Large Vessel Vasculitis: Correlation With Positron Emission Tomography Findings. Arthritis Care Res 2017; 69: 143-149