Domain | Definition | Agreement (%) | Delphi round |
US appearance of | |||
normal temporal arteries | Pulsating, compressible artery with anechoic lumen surrounded by mid-echoic to hyperechoic* tissue. Using US equipment with high resolution, the intima-media complex presenting as a homogenous, hypoechoic or anechoic echostructure delineated by two parallel hyperechoic margins (‘double line pattern’) may be visible. | 95.7 | 1 |
normal extracranial large arteries | Pulsating, hardly compressible artery with anechoic lumen; the intima-media complex presents as a homogenous, hypoechoic or anechoic echostructure delineated by two parallel hyperechoic margins (‘double line pattern’), which is surrounded by mid-echoic to hyperechoic tissue. | 100 | 1 |
arteriosclerotic arteries | Heterogeneous and in part hyperechoic, irregularly delineated and eccentric vessel wall alteration. | 95.8 | 2 |
‘halo’ sign | Homogenous, hypoechoic wall thickening, well delineated towards the luminal side, visible both in longitudinal and transverse planes, most commonly concentric in transverse scans. | 91.3 | 2 |
stenosis in temporal arteries | A stenosis is characterised by aliasing and persistent diastolic flow by colour Doppler US. The maximum systolic flow velocity determined within the stenosis by pulsed wave-Doppler US is ≥2 times higher than the flow velocity proximal or distal to the stenosis. | 95.8 100 | 2 3 |
stenosis in extracranial large arteries | Typical vasculitic vessel wall thickening with characteristic Doppler curves showing turbulence and increased systolic and diastolic blood flow velocities. | 75 | 1 |
occlusion | Absence of colour Doppler signals in a visible artery filled with hypoechoic material, even with low pulse repetition frequency and high colour gain. | 87.5 | 1 |
‘compression’ sign of temporal arteries | The thickened arterial wall remains visible upon compression; the hypoechogenic vasculitic vessel wall thickening contrasts with the mid-echogenic to hyperechogenic surrounding tissue. | 78.3 | 1 |
US assessment of | |||
‘compression’ sign of temporal arteries | The compression sign should be assessed by applying pressure via the transducer until the lumen of the temporal artery occludes and no arterial pulsation remains visible. | 91.3 | 1 |
↵*The term ‘midechoic’ is equivalent to the term ‘isoechoic’.