Transorbital ultrasound in the diagnosis of giant cell arteritis
The objective of this study was to prospectively evaluate the diagnostic efficacy of transorbital ultrasound (TOS) in patients newly diagnosed with giant cell arteritis (GCA), presenting with visual symptoms. Patients with newly diagnosed, untreated GCA were examined using TOS, assessing central ret...
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| Veröffentlicht in: | Rheumatology (Oxford, England) Jg. 63; H. 9; S. 2379 |
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01.09.2024
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| Abstract | The objective of this study was to prospectively evaluate the diagnostic efficacy of transorbital ultrasound (TOS) in patients newly diagnosed with giant cell arteritis (GCA), presenting with visual symptoms.
Patients with newly diagnosed, untreated GCA were examined using TOS, assessing central retinal artery flow velocity [peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI)], and optic nerve diameter (OND). Vascular ultrasound was conducted to evaluate the superficial temporal arteries, their branches, facial, axillary, carotid, and vertebral arteries.
We enrolled 54 GCA patients, 27 with visual symptoms, and 27 healthy controls. Eyes of GCA patients with visual symptoms demonstrated significantly lower PSV and EDV (PSV: β = -1.91; P = 0.029; EDV: β = -0.57; P = 0.032) and significantly elevated OND (β = 0.79; P = 0.003) compared with controls. RI did not significantly differ from controls (β = -0.06, P = 0.129). Vascular ultrasound identified an average of 8.7 (SD ± 2.8) pathological vessels per GCA patient. A significant negative association was observed between the number of affected vessels and both PSV (P = 0.048) and EDV (P = 0.040). No association was found with RI (P = 0.249), while a positive significant association was noted with OND (P < 0.001).
This study pioneers the application of TOS to assess structural eye changes in newly diagnosed, untreated GCA patients with visual symptoms. Our findings suggest reduced central retinal artery flow and increased optic nerve diameter as potential biomarkers for serious ocular involvement in GCA. The detected association between internal and external carotid artery involvement indicates a common pathophysiological mechanism underlying systemic and ocular manifestations of GCA. |
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| AbstractList | The objective of this study was to prospectively evaluate the diagnostic efficacy of transorbital ultrasound (TOS) in patients newly diagnosed with giant cell arteritis (GCA), presenting with visual symptoms.OBJECTIVESThe objective of this study was to prospectively evaluate the diagnostic efficacy of transorbital ultrasound (TOS) in patients newly diagnosed with giant cell arteritis (GCA), presenting with visual symptoms.Patients with newly diagnosed, untreated GCA were examined using TOS, assessing central retinal artery flow velocity [peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI)], and optic nerve diameter (OND). Vascular ultrasound was conducted to evaluate the superficial temporal arteries, their branches, facial, axillary, carotid, and vertebral arteries.METHODSPatients with newly diagnosed, untreated GCA were examined using TOS, assessing central retinal artery flow velocity [peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI)], and optic nerve diameter (OND). Vascular ultrasound was conducted to evaluate the superficial temporal arteries, their branches, facial, axillary, carotid, and vertebral arteries.We enrolled 54 GCA patients, 27 with visual symptoms, and 27 healthy controls. Eyes of GCA patients with visual symptoms demonstrated significantly lower PSV and EDV (PSV: β = -1.91; P = 0.029; EDV: β = -0.57; P = 0.032) and significantly elevated OND (β = 0.79; P = 0.003) compared with controls. RI did not significantly differ from controls (β = -0.06, P = 0.129). Vascular ultrasound identified an average of 8.7 (SD ± 2.8) pathological vessels per GCA patient. A significant negative association was observed between the number of affected vessels and both PSV (P = 0.048) and EDV (P = 0.040). No association was found with RI (P = 0.249), while a positive significant association was noted with OND (P < 0.001).RESULTSWe enrolled 54 GCA patients, 27 with visual symptoms, and 27 healthy controls. Eyes of GCA patients with visual symptoms demonstrated significantly lower PSV and EDV (PSV: β = -1.91; P = 0.029; EDV: β = -0.57; P = 0.032) and significantly elevated OND (β = 0.79; P = 0.003) compared with controls. RI did not significantly differ from controls (β = -0.06, P = 0.129). Vascular ultrasound identified an average of 8.7 (SD ± 2.8) pathological vessels per GCA patient. A significant negative association was observed between the number of affected vessels and both PSV (P = 0.048) and EDV (P = 0.040). No association was found with RI (P = 0.249), while a positive significant association was noted with OND (P < 0.001).This study pioneers the application of TOS to assess structural eye changes in newly diagnosed, untreated GCA patients with visual symptoms. Our findings suggest reduced central retinal artery flow and increased optic nerve diameter as potential biomarkers for serious ocular involvement in GCA. The detected association between internal and external carotid artery involvement indicates a common pathophysiological mechanism underlying systemic and ocular manifestations of GCA.CONCLUSIONSThis study pioneers the application of TOS to assess structural eye changes in newly diagnosed, untreated GCA patients with visual symptoms. Our findings suggest reduced central retinal artery flow and increased optic nerve diameter as potential biomarkers for serious ocular involvement in GCA. The detected association between internal and external carotid artery involvement indicates a common pathophysiological mechanism underlying systemic and ocular manifestations of GCA. The objective of this study was to prospectively evaluate the diagnostic efficacy of transorbital ultrasound (TOS) in patients newly diagnosed with giant cell arteritis (GCA), presenting with visual symptoms. Patients with newly diagnosed, untreated GCA were examined using TOS, assessing central retinal artery flow velocity [peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI)], and optic nerve diameter (OND). Vascular ultrasound was conducted to evaluate the superficial temporal arteries, their branches, facial, axillary, carotid, and vertebral arteries. We enrolled 54 GCA patients, 27 with visual symptoms, and 27 healthy controls. Eyes of GCA patients with visual symptoms demonstrated significantly lower PSV and EDV (PSV: β = -1.91; P = 0.029; EDV: β = -0.57; P = 0.032) and significantly elevated OND (β = 0.79; P = 0.003) compared with controls. RI did not significantly differ from controls (β = -0.06, P = 0.129). Vascular ultrasound identified an average of 8.7 (SD ± 2.8) pathological vessels per GCA patient. A significant negative association was observed between the number of affected vessels and both PSV (P = 0.048) and EDV (P = 0.040). No association was found with RI (P = 0.249), while a positive significant association was noted with OND (P < 0.001). This study pioneers the application of TOS to assess structural eye changes in newly diagnosed, untreated GCA patients with visual symptoms. Our findings suggest reduced central retinal artery flow and increased optic nerve diameter as potential biomarkers for serious ocular involvement in GCA. The detected association between internal and external carotid artery involvement indicates a common pathophysiological mechanism underlying systemic and ocular manifestations of GCA. |
| Author | Terheyden, Jan H Schäfer, Valentin S Burg, Lara C Petzinna, Simon M Bauer, Claus-Juergen Karakostas, Pantelis Holz, Frank G Finger, Robert P Behning, Charlotte Brossart, Peter |
| Author_xml | – sequence: 1 givenname: Simon M orcidid: 0000-0002-4686-1143 surname: Petzinna fullname: Petzinna, Simon M organization: Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital of Bonn, Bonn, Germany – sequence: 2 givenname: Lara C orcidid: 0000-0002-5379-9149 surname: Burg fullname: Burg, Lara C organization: Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital of Bonn, Bonn, Germany – sequence: 3 givenname: Claus-Juergen surname: Bauer fullname: Bauer, Claus-Juergen organization: Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital of Bonn, Bonn, Germany – sequence: 4 givenname: Pantelis surname: Karakostas fullname: Karakostas, Pantelis organization: Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital of Bonn, Bonn, Germany – sequence: 5 givenname: Jan H surname: Terheyden fullname: Terheyden, Jan H organization: Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany – sequence: 6 givenname: Charlotte surname: Behning fullname: Behning, Charlotte organization: Institute of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany – sequence: 7 givenname: Frank G surname: Holz fullname: Holz, Frank G organization: Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany – sequence: 8 givenname: Peter surname: Brossart fullname: Brossart, Peter organization: Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital of Bonn, Bonn, Germany – sequence: 9 givenname: Robert P surname: Finger fullname: Finger, Robert P organization: Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany – sequence: 10 givenname: Valentin S surname: Schäfer fullname: Schäfer, Valentin S organization: Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital of Bonn, Bonn, Germany |
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| Copyright | The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com. |
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| Keywords | giant cell arteritis transorbital ultrasound vascular ultrasound inflammation vasculitis |
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| SubjectTerms | Aged Aged, 80 and over Blood Flow Velocity Carotid Arteries - diagnostic imaging Carotid Arteries - physiopathology Case-Control Studies Female Giant Cell Arteritis - diagnostic imaging Giant Cell Arteritis - physiopathology Humans Male Middle Aged Optic Nerve - diagnostic imaging Orbit - blood supply Orbit - diagnostic imaging Prospective Studies Retinal Artery - diagnostic imaging Temporal Arteries - diagnostic imaging Temporal Arteries - pathology Ultrasonography - methods |
| Title | Transorbital ultrasound in the diagnosis of giant cell arteritis |
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