The contribution of ultrasound of the craniocervical arteries to the diagnosis of giant cell arteritis

Aim: Evaluation of the diagnostic contribution of color duplex sonography of the temporal, carotid and vertebral arteries and doppler sonography of the periorbital arteries in patients with and without giant cell arteries (GCA) particularly to distinguish between arteritic and nonarteritic neuro-ophthalmological vascular complications (NOC). Methods: In a prospective study ultrasonographic findings in 85 GCA patients without NOC and 47 GCA patients with NOC were compared to those of 33 non GCA patients with NOC. Concentric hypoechogenic mural thickening (a so called halo) was considered as a GCA typical ultrasonographic finding. Absent or retrograde signals not corresponding to carotid occlusive disease were classified as a GCA typical doppler sonographic finding of the periorbital arteries. Results: GCA patients with NOC had significantly higher rates of abnormal ultrasonographic findings of the temporal (81% vs 62%) and periorbital arteries (32% vs 5%) than GCA patients without NOC. In patients with other diagnoses and NOC halos were found in 9%, whereas halos and stenosis and GCA typical findings of the periorbital arteries were absent. Conclusion: Typical ultrasonographic findings of the craniocervical arteries help to distinguish between arteritic and nonarteritic NOC. In patients with GCA typical ultrasonographic findings in at least 2 different arteries biopsy taking seems not obligatory.