THE ROLE OF ULTRASOUND BIOMICROSCOPY IN PREDICTING THE RESULT OF TEMPORAL ARTERY BIOPSY IN TEMPORAL ARTERITIS PATIENTS

Abstract

Abstract: : Purpose: Temporal artery biopsy is considered the gold standard for the diagnosis of temporal arteritis. However, complications following this procedure can occasionally occur. The goal of this study is to evaluate if ultrasound biomicroscopy (UBM) findings are useful in predicting the result (positive or negative) of temporal artery biopsies in patients with temporal arteritis. Methods: Twenty–six consecutive patients with clinical diagnosis of temporal arteritis seen at the Department of Ophthalmology, Royal Victoria Hospital, McGill University Heath Center, Montreal, Canada, were enrolled in this study. All patients were submitted to UBM before temporal artery biopsy. Eight patients presented histopathological findings consistent with the diagnosis of temporal arteritis. Thus, UBM findings of these patients were compared with those from 18 patients with negative biopsy. In UBM we searched for the presence of a hypoechoic effect surrounding the walls of the temporal arteries, the so–called "halo sign", as well as an intra–arterial middle reflexive filling, the so–called "intra–arterial filling". Results: Both the "halo sign" and the "intra–arterial filling" were simultaneously found in 5 (62.5%) of 8 patients with biopsy–proven temporal arteritis. However, only 6 (30%) of 18 patients with a negative biopsy presented both features simultaneously. On the other hand, the absence of these two parameters on the UBM of a patient with the clinical diagnosis of temporal arteritis strongly suggests that the temporal artery biopsy will be negative (negative predictive value=100%). Conclusions: This data suggests that the UBM is a useful exam in predicting the negative result of the temporal artery biopsy in patients with temporal arteritis. In the present series approximately 30% of the affected patients could be spared this surgical procedure and possible complications.

Keywords: autoimmune disease • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)