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The value of ultrasound in diagnosing giant cell arteritis : comparing the intima-media thickness of the temporal and axillary arteries between manual longitudinal, semi-automatic longitudinal and transversally compressed measurements

Lau, Alexander (2019) The value of ultrasound in diagnosing giant cell arteritis : comparing the intima-media thickness of the temporal and axillary arteries between manual longitudinal, semi-automatic longitudinal and transversally compressed measurements.

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Abstract:Background: Giant cell arteritis (GCA) is a common medium-/large-sized vessel vasculitis that can result in blindness. An accurate early GCA diagnosis can minimize such complications, but temporal artery biopsy (TAB), the diagnostic gold standard, is moderately sensitive (39%) and not timely. Ultrasound (US) is a promising alternative that can show GCA lesions, such as an enlarged arterial intima-media thickness (IMT). However, US is highly operator-dependent. Objective: (1) Investigate the diagnostic value of US for GCA, compared to TAB; (2) investigate and possibly improve US reliability with a semi-automatic algorithm or eminence-based transversal compression technique. Methods: A retrospective cohort and pilot study were conducted to reach objective 1 and 2, respectively. The retrospective cohort study included suspected GCA patients, whose initial visit to the Rheumatology Department of the Dutch hospital ZGT, was between 01-01-2017 and 06-01-2018. The pilot study entailed ten healthy subjects, who were examined by two sonographers and whose longitudinal images and transversal images with vessel compression were recorded for the common temporal artery (CTA), frontal temporal artery (FTA) and axillary artery (AX). IMT measurements were performed by both sonographers and twice with the semi-automatic algorithm. The manual longitudinal, semi-automatic longitudinal and transversally compressed IMT measurements were compared using the intraclass correlation coefficient (ICC). Results: Retrospective cohort study: the sample encompassed 103 patients, 34 GCA and 69 non-GCA. 100 US and 46 TAB examinations were performed. US and TAB respectively had a 75.8% and 80.8% sensitivity, and both had a 100% specificity. Pilot study: the ICC between semi-automatic and manual longitudinal measurements was moderate for the CTA (0.75) and FTA (0.56), but good for the AX (0.81). The ICC between transversally compressed and manual longitudinal measurements was poor for the CTA (0.27), FTA (0.25) and AX (0.14). The ICC between the manual longitudinal measurements was moderate for the CTA (0.57) and FTA (0.60), but good for the AX (0.87). The ICC between the transversally compressed measurements was moderate for the CTA (0.52), FTA (0.63) and AX (0.71). Lastly, the ICC between the semi-automatic longitudinal measurements was very good for the CTA (1.00), FTA (0.99) and AX (1.00). Conclusion: US is a viable alternative to TAB for diagnosing GCA early. Semi-automatic longitudinal IMT measurements are as valid as manual longitudinal measurements and highly reliable. Transversally compressed IMT measurements are less valid than manual longitudinal measurements, but the reliability is comparable for the CTA and FTA, and lower for the AX.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/79449
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