Meta-analysis: test performance of ultrasonography for giant-cell arteritis

Ann Intern Med. 2005 Mar 1;142(5):359-69. doi: 10.7326/0003-4819-142-5-200503010-00011.


Background: Giant-cell arteritis is a diagnostic challenge.

Purpose: To determine the diagnostic performance of ultrasonography for giant-cell arteritis.

Data sources: Studies published up to April 2004 in the MEDLINE, EMBASE, and Cochrane databases; reference lists; and direct contact with investigators.

Study selection: Studies in any language that examined temporal artery ultrasonography for diagnosis of giant-cell arteritis, enrolled at least 5 patients, and used biopsy or the American College of Rheumatology (ACR) criteria as the reference standard.

Data extraction: Two reviewers independently graded methodologic quality and abstracted data on sensitivity and specificity of ultrasonography for giant-cell arteritis. Diagnostic performance was determined for the halo sign, stenosis, or occlusion and for any of these ultrasonographic abnormalities.

Data synthesis: Weighted sensitivity and specificity estimates and summary receiver-operating characteristic (ROC) curve analysis were used. Twenty-three studies, involving a total of 2036 patients, met the inclusion criteria. The weighted sensitivity and specificity of the halo sign were 69% (95% CI, 57% to 79%) and 82% (CI, 75% to 87%), respectively, compared with biopsy and 55% (CI, 36% to 73%) and 94% (CI, 82% to 98%), respectively, compared with ACR criteria. Stenosis or occlusion was an almost equally sensitive marker compared with either biopsy (sensitivity, 68% [CI, 49% to 82%]) or ACR criteria (sensitivity, 66% [CI, 32% to 89%]). Consideration of any vessel abnormality nonsignificantly improved diagnostic performance compared with ACR criteria. Between-study heterogeneity was significant, but summary ROC curves were consistent with weighted estimates. When the pretest probability of giant-cell arteritis is 10%, negative results on ultrasonography practically exclude the disease (post-test probability, 2% to 5% for various analyses).

Limitations: The primary studies were small and of modest quality and had considerable heterogeneity.

Conclusion: Ultrasonography may be helpful in diagnosing giant-cell arteritis, but cautious interpretation of the test results based on clinical presentation and pretest probability of the disease is imperative.

Publication types

  • Meta-Analysis

MeSH terms

  • Adult
  • Aged
  • Biopsy
  • Female
  • Giant Cell Arteritis / diagnostic imaging*
  • Humans
  • Male
  • Middle Aged
  • ROC Curve
  • Reference Standards
  • Research Design / standards
  • Sensitivity and Specificity
  • Temporal Arteries / diagnostic imaging*
  • Ultrasonography / standards