Definitions and reliability assessment of elementary ultrasound lesions in giant cell arteritis: a study from the OMERACT Large Vessel Vasculitis Ultrasound Working Group

Stavros Chrysidis, Christina Duftner, Christian Dejaco, Valentin S Schäfer, Sofia Ramiro, Greta Carrara, Carlo Alberto Scirè, Alojzija Hocevar, Andreas P Diamantopoulos, Annamaria Iagnocco, Chetan Mukhtyar, Cristina Ponte, Esperanza Naredo, Eugenio De Miguel, George A Bruyn, Kenneth J Warrington, Lene Terslev, Marcin Milchert, Maria Antonietta D'Agostino, Mattew J KosterNaina Rastalsky, Petra Hanova, Pierluigi Macchioni, Tanaz A Kermani, Tove Lorenzen, Uffe Møller Døhn, Ulrich Fredberg, Wolfgang Hartung, Bhaskar Dasgupta, Wolfgang A Schmidt

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Abstract

Objectives: To define the elementary ultrasound (US) lesions in giant cell arteritis (GCA) and to evaluate the reliability of the assessment of US lesions according to these definitions in a web-based reliability exercise.

Methods: Potential definitions of normal and abnormal US findings of temporal and extracranial large arteries were retrieved by a systematic literature review. As a subsequent step, a structured Delphi exercise was conducted involving an expert panel of the Outcome Measures in Rheumatology (OMERACT) US Large Vessel Vasculitis Group to agree definitions of normal US appearance and key elementary US lesions of vasculitis of temporal and extracranial large arteries. The reliability of these definitions on normal and abnormal blood vessels was tested on 150 still images and videos in a web-based reliability exercise.

Results: Twenty-four experts participated in both Delphi rounds. From originally 25 statements, nine definitions were obtained for normal appearance, vasculitis and arteriosclerosis of cranial and extracranial vessels. The 'halo' and 'compression' signs were the key US lesions in GCA. The reliability of the definitions for normal temporal and axillary arteries, the 'halo' sign and the 'compression' sign was excellent with inter-rater agreements of 91-99% and mean kappa values of 0.83-0.98 for both inter-rater and intra-rater reliabilities of all 25 experts.

Conclusions: The 'halo' and the 'compression' signs are regarded as the most important US abnormalities for GCA. The inter-rater and intra-rater agreement of the new OMERACT definitions for US lesions in GCA was excellent.

Original languageEnglish
Article numbere000598
JournalBMJ Open
Volume4
Issue number1
DOIs
Publication statusPublished - 17 May 2018

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