Vascular ultrasound for the diagnosis of giant cell arteritis: a reliability and agreement study based on a standardised training programme

Stavros Chrysidis, Lene Terslev, Robin Christensen, Ulrich Fredberg, Knud Larsen, Tove Lorenzen, Uffe Møller Døhn, Andreas P. Diamantopoulos

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Abstract

OBJECTIVE: To evaluate the impact of a standardised training programme including equipment adjustment for experienced musculoskeletal ultrasonographers without previous experience in vascular ultrasound (US) on the reliability of US in the diagnosis of giant cell arteritis (GCA). METHODS: In this prospective, non-interventional observational cohort study, patients suspected of GCA were evaluated by US by one of five rheumatologists with long-standing experience in musculoskeletal US (>8 years), trained using a standardised training programme including equipment adjustment. Images of cranial and large vessels were subsequently evaluated first by the performing ultrasonographer and thereafter by a blinded external expert (gold standard). RESULTS: In three Danish centres, 112 patients suspected of GCA were included. According to the external expert, vasculitis changes were seen in 66 patients, in 45 of them with only cranial involvement, in 14 with both cranial and large vessel involvement, while in seven patients isolated large vessel vasculitis was found. The reliability was excellent between the local ultrasonographer and the US expert for the overall GCA diagnosis regarding the diagnosis of cranial and for large vessel GCA, with an interobserver agreement of 95-96%, mean kappa values of 0.88-0.92 (95% CI 0.78 to 0.99). Excellent reliability (mean kappa 0.86-1.00) was also found for the US examination of the individual arteries (temporal, facial, common carotid and axillary). CONCLUSION: The US training programme resulted in excellent agreement between trainees and an expert in patients suspected of GCA and may thus be applicable for implementation of vascular US in clinical practice.

Original languageEnglish
Article numbere001337
JournalRMD Open
Volume6
Issue number3
Number of pages7
ISSN2056-5933
DOIs
Publication statusPublished - 1. Sept 2020

Keywords

  • Giant Cell Arteritis
  • Systemic vasculitis
  • Ultrasonography

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