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Ultrasonography of the temporal, periorbital and carotid arteries in the diagnosis of giant cell arteritis and its neuroophthalmological complications.

AIM
Evaluation of the diagnostic contribution of colour duplex sonography of the superficial temporal and the carotid arteries and Doppler sonography of the periorbital arteries by analysing the results in patients with giant cell arteritis with and without neuroophthalmological complications and patients with other diagnoses and neuroophthalmological complications.


METHODS
In a case control study, ultrasonographic findings in patients with neuroophthalmological complications (25 giant cell arteritis, 23 non giant cell arteritis) were compared to those of 62 patients suffering from giant cell arteritis without neuroophthalmological complications. Concentric hypoechogenic mural thickening (a so-called halo) was considered as an ultrasonographic finding typical of giant cell arteritis. Absent or retrograde signals not corresponding to carotid occlusive disease were classified as Doppler sonographic findings typical of giant cell arteritis of the periorbital arteries.


RESULTS
There are higher rates of abnormalities in Doppler sonography of the periorbital arteries as well as halos in combination with stenosis of the temporal arteries in patients with giant cell arteritis with neuroophthalmological complications. This suggests that in patients with giant cell arteritis and neuroophthalmological complications, the haemodynamic situation is more severely disturbed. Patients suffering from giant cell arteritis with and without neuroophthalmological complications had the same rate of temporal artery abnormalities on colour duplex sonography (72 vs. 71 %), whereas abnormalities in the periorbital arteries were clearly different (40 vs. 8 %). Only 1 patient with giant cell arteritis without neuroophthalmological complication had anomalies of the carotid arteries typical of giant cell arteritis. In patients with other diagnoses and neuroophthalmological complications, the rate of anomalies in temporal artery colour duplex sonography and Doppler sonography of the periorbital arteries was 9 % and 0 %.


CONCLUSION
Colour duplex sonography of the superficial temporal and carotid arteries and Doppler sonograpy of the periorbital arteries are complementary methods and should be part of the evaluation of all patients suspected to suffer from giant cell arteritis.