Letter to the Editor
Comparison between power doppler ultrasound and temporal artery biopsy in the diagnosis of giant cell arteritis. Open debate
Comparativa entre ecografía Doppler frente a la biopsia de arteria temporal en el diagnóstico de la arteritis de células gigantes. Debate abierto
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Debate abierto" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "121" "paginaFinal" => "122" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Comparison Between Power Doppler Ultrasound and Temporal Artery Biopsy in the Diagnosis of Giant Cell Arteritis. Open Debate" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2132 "Ancho" => 2167 "Tamanyo" => 163771 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Propuesta de algoritmo de actuación ante la sospecha de arteritis de células gigantes (ACG).</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Alta sospecha clínica: edad >50 años y 1) con síntomas cefálicos exclusivos (cefalea de instauración reciente, claudicación mandibular o alteraciones visuales); 2) con polimialgia reumática, según criterios EULAR/ACR 2017; 3) con síndrome tóxico o febril inespecífico, una vez descartadas causas infecciosas y con despistaje para neoplasias negativo, y 4) con ictus en territorio vertebrobasilar, sin antecedentes cardiovasculares relevantes ni hallazgos de etiología aterogénica o embólica tras estudio dirigido.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">ACG: arteritis de células gigantes; BAT: biopsia arteria temporal; ECO T: ecografía arterias temporales; INDET: resultado indeterminado.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Héctor Corominas, Paula Estrada Alarcón, Patricia Moya, Dèlia Reina Sanz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Héctor" "apellidos" => "Corominas" ] 1 => array:2 [ "nombre" => "Paula" "apellidos" => "Estrada Alarcón" ] 2 => array:2 [ "nombre" => "Patricia" "apellidos" => "Moya" ] 3 => array:2 [ "nombre" => "Dèlia" "apellidos" => "Reina Sanz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574320300083" "doi" => "10.1016/j.reumae.2019.03.004" "estado" => 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Editor</span>" "titulo" => "Comparison between power doppler ultrasound and temporal artery biopsy in the diagnosis of giant cell arteritis. Open debate" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor,</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "121" "paginaFinal" => "122" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Héctor Corominas, Paula Estrada Alarcón, Patricia Moya, Dèlia Reina Sanz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Héctor" "apellidos" => "Corominas" "email" => array:1 [ 0 => "vancor@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Paula" "apellidos" => "Estrada Alarcón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Patricia" "apellidos" => "Moya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Dèlia Reina" "apellidos" => "Sanz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unitat territorial de Reumatologia i Malalties autoinmunes sistèmiques, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servei de Reumatologia, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comparativa entre ecografía Doppler frente a la biopsia de arteria temporal en el diagnóstico de la arteritis de células gigantes. Debate abierto" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2132 "Ancho" => 2167 "Tamanyo" => 163771 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Proposed algorithm for action in case of suspicion of giant cell arteritis (GCA).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">High level of clinical suspicion: age >50 years old and 1) with exclusively cephalic symptoms (cephalea that commenced recently, jaw claudication or visual alterations); 2) with rheumatic polymyalgia, according to EULAR/ACR 2017 criteria; 3) with toxic syndrome or non-specific fever syndrome, once infectious causes have been ruled out and screening for neoplasia has proved negative, and 4) with ictus in vertebrobasilar territory, with no relevant cardiovascular history or findings with an atherogenic or embolic etiology after a directed study.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">GCA: giant cell arteritis; TAB: temporal artery biopsy; TAUS: temporal artery ultrasound scan; INDET: indeterminate result.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The description of the controversy regarding the use of Doppler ultrasound or biopsy published by González Porto et al. is of very high quality. The authors conclude that ultrasound scan is of restricted usefulness in giant cell arteritis (GCA) and recognise that there is a need for prospective studies.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We also consider the reply by de Miguel et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> to be highly relevant, with its description of technical and methodological data, and we would like to add a few remarks with the aim of improving the procedure for ultrasound scan in GCA.</p><p id="par0010" class="elsevierStylePara elsevierViewall">According to the recent EULAR 2018<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> recommendations, it is important to use a multifrequency transponder, and it is recommended that one of less than 15 MHz be used, as de Miguel et al. remark. In our experience we too use frequencies of 15 MHz for a scale of greys and Doppler in colour (60% gain and PRF of 1,5–2 kHz), and all such tasks are performed by ultrasound technicians who have been trained in the said technique. One very important detail is that we must not restrict evaluation to the superficial temporal arteries. According to the data published by Schäffer et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> we should measure and evaluate the inner and middle layers of the common superficial temporal artery (cut point: 0.42 mm), the parietal branch (0.29 mm), the frontal branch (0.34 mm), the facial artery (0.37 mm) and the axillary artery (1.0 mm), as all of these have a sensitivity of from 87% for the lowest up to 100%.</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is here where, as was said, the procedure has gradually been improved, and training in the said technique may improve the sensitivity parameters (S) and the specificity parameters (E). When they reviewed their data, de Miguel et al. found that they had improved over the years, until they obtained S of 91.6% and E of 95.83%.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In our case, in 2018 we obtained an S and E of 81.8 and 93.3%, respectively, with a positive predictive value of 90.1% and a negative predictive value of 87.5%, all without evaluating the axillary artery, although it is now regarded as essential to do this.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, respecting the open debate on the utility of ultrasound scan imaging in GCA, which was awarded a score of 5 points, and the recent EULAR<span class="elsevierStyleSup">3</span> recommendations document, it is considered to be a test with very diagnostic value when performed by an expert. Likewise, it must be said that there are other complementary imaging techniques which should be evaluated to detect wall or luminal inflammation in extracraneal arteries in the case of large vessel vasculitis such as GCA. It also has to be pointed out that ultrasound scan is of limited value in cases of aortitis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We understand that an algorithm should be used to decide whether a cohort has low or high clinical suspicion, deciding on the basis of the result whether or not to perform a superficial temporal artery biopsy. Nevertheless, this algorithm deserves its own particular debate (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Corominas H, Estrada Alarcón P, Moya P, Sanz DR. Comparativa entre ecografía Doppler frente a la biopsia de arteria temporal en el diagnóstico de la arteritis de células gigantes. Debate abierto. Reumatol Clin. 2021;17:121–122.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2132 "Ancho" => 2167 "Tamanyo" => 163771 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Proposed algorithm for action in case of suspicion of giant cell arteritis (GCA).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">High level of clinical suspicion: age >50 years old and 1) with exclusively cephalic symptoms (cephalea that commenced recently, jaw claudication or visual alterations); 2) with rheumatic polymyalgia, according to EULAR/ACR 2017 criteria; 3) with toxic syndrome or non-specific fever syndrome, once infectious causes have been ruled out and screening for neoplasia has proved negative, and 4) with ictus in vertebrobasilar territory, with no relevant cardiovascular history or findings with an atherogenic or embolic etiology after a directed study.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">GCA: giant cell arteritis; TAB: temporal artery biopsy; TAUS: temporal artery ultrasound scan; INDET: indeterminate result.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio comparativo de la ecografía Doppler frente a la biopsia de arteria temporal en el diagnóstico de la arteritis de células gigantes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.A. González Porto" 1 => "M.T. Silva Díaz" 2 => "A. Reguera Arias" 3 => "J. Pombo Otero" 4 => "A. González Rodríguez" 5 => "J. Valero Gasalla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2018.08.007" "Revista" => array:2 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2018" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "de Miguel E., Monjo I. Respuesta a: Estudio comparativo de la ecografía Doppler frente a la biopsia de arteria temporal en el diagnóstico de la arteritis de células gigantes 10.1016/j.reuma.2018.11.001." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Dejaco" 1 => "S. Ramiro" 2 => "C. Duftner" 3 => "F.J. Besson" 4 => "T.A. Bley" 5 => "D. Blockmans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2017-212649" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2018" "volumen" => "77" "paginaInicial" => "636" "paginaFinal" => "643" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29358285" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound cut-off values for intima-media thickness of temporal, facial and axillary arteries in giant cell arteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V.S. Schäfer" 1 => "A. Juche" 2 => "S. Ramiro" 3 => "A. Krause" 4 => "W.A. Schmidt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/kex143" "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2017" "volumen" => "56" "paginaInicial" => "1479" "paginaFinal" => "1483" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diag- nostic validity of Doppler ultrasound in giant cell arteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.C. Aranda-Valera" 1 => "S. García Carazo" 2 => "I. Monjo Henry" 3 => "E. de Miguel Mendieta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2017" "volumen" => "103" "numero" => "Suppl 35" "paginaInicial" => "S123" "paginaFinal" => "7" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Doppler ultrasonography of superficial temporal artery in a cohort of patients with strong clinical suspicion of giant cell arteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Estrada Alarcón" 1 => "D. Reina" 2 => "V. Navarro Ángeles" 3 => "D. Cerdà" 4 => "D. Roig-Vilaseca" 5 => "H. Corominas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2018.04.016" "Revista" => array:2 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2018" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001700000002/v1_202101301156/S2173574320300083/v1_202101301156/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001700000002/v1_202101301156/S2173574320300083/v1_202101301156/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320300083?idApp=UINPBA00004M" ]
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| 2024 August | 57 | 31 | 88 |
| 2024 July | 42 | 21 | 63 |
| 2024 June | 52 | 30 | 82 |
| 2024 May | 47 | 28 | 75 |
| 2024 April | 62 | 24 | 86 |
| 2024 March | 56 | 27 | 83 |
| 2024 February | 53 | 25 | 78 |
| 2024 January | 60 | 30 | 90 |
| 2023 December | 30 | 25 | 55 |
| 2023 November | 45 | 32 | 77 |
| 2023 October | 31 | 33 | 64 |
| 2023 September | 61 | 38 | 99 |
| 2023 August | 55 | 16 | 71 |
| 2023 July | 33 | 21 | 54 |
| 2023 June | 46 | 31 | 77 |
| 2023 May | 47 | 20 | 67 |
| 2023 April | 28 | 7 | 35 |
| 2023 March | 77 | 28 | 105 |
| 2023 February | 72 | 24 | 96 |
| 2023 January | 57 | 17 | 74 |
| 2022 December | 85 | 41 | 126 |
| 2022 November | 60 | 29 | 89 |
| 2022 October | 111 | 35 | 146 |
| 2022 September | 53 | 27 | 80 |
| 2022 August | 48 | 45 | 93 |
| 2022 July | 57 | 36 | 93 |
| 2022 June | 52 | 30 | 82 |
| 2022 May | 47 | 34 | 81 |
| 2022 April | 51 | 35 | 86 |
| 2022 March | 96 | 45 | 141 |
| 2022 February | 54 | 37 | 91 |
| 2022 January | 42 | 35 | 77 |
| 2021 December | 37 | 33 | 70 |
| 2021 November | 42 | 36 | 78 |
| 2021 October | 106 | 51 | 157 |
| 2021 September | 46 | 36 | 82 |
| 2021 August | 24 | 18 | 42 |
| 2021 February | 1 | 0 | 1 |
| 2020 March | 1 | 0 | 1 |
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