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Definitions and reliability assessment of elementary ultrasound lesions in giant cell arteritis: a study from the OMERACT Large Vessel Vasculitis Ultrasound Working Group
  1. Stavros Chrysidis1,
  2. Christina Duftner2,
  3. Christian Dejaco3,4,
  4. Valentin S Schäfer5,
  5. Sofia Ramiro6,
  6. Greta Carrara7,
  7. Carlo Alberto Scirè7,8,
  8. Alojzija Hocevar9,
  9. Andreas P Diamantopoulos10,
  10. Annamaria Iagnocco11,
  11. Chetan Mukhtyar12,
  12. Cristina Ponte13,
  13. Esperanza Naredo14,
  14. Eugenio De Miguel15,
  15. George A Bruyn16,
  16. Kenneth J Warrington17,
  17. Lene Terslev18,
  18. Marcin Milchert19,
  19. Maria Antonietta D’Agostino20,
  20. Mattew J Koster17,
  21. Naina Rastalsky21,
  22. Petra Hanova22,
  23. Pierluigi Macchioni23,
  24. Tanaz A Kermani24,
  25. Tove Lorenzen25,
  26. Uffe Møller Døhn18,
  27. Ulrich Fredberg25,26,
  28. Wolfgang Hartung27,
  29. Bhaskar Dasgupta28 and
  30. Wolfgang A Schmidt29
  1. 1 Department of Rheumatology, Hospital of Southwest Jutland, Esbjerg, Denmark
  2. 2 Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
  3. 3 Department of Rheumatology, Medical University of Graz, Graz, Austria
  4. 4 Department of Rhematology, Hospital of Bruneck, Bruneck, Italy
  5. 5 III. Medical Clinic, Department of Oncology, Hematology and Rheumatology, University Hospital Bonn, Berlin, Germany
  6. 6 Leiden University Medical Center, Leiden, The Netherlands
  7. 7 Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
  8. 8 Department of Rheumatology, University of Ferrara, Ferrara, Italy
  9. 9 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  10. 10 Martina Hansens Hospital, Bærum, Oslo, Norway
  11. 11 Dipartimento Scienze Cliniche e Biologiche - Reumatologia, Università degli Studi di Torino, Torino, Italy
  12. 12 Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
  13. 13 Hospital de Santa Maria - CHLN, Lisbon Academic Medical Centre, Lisbon, Portugal
  14. 14 Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
  15. 15 University Hospital La Paz, Madrid, Spain
  16. 16 MC Groep Hospitals, Lelystad, The Netherlands
  17. 17 Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
  18. 18 Copenhagen Center for Arthritis Research (COPECARE), Copenhagen, Denmark
  19. 19 Department of Rheumatology and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
  20. 20 Hôpital Ambroise Paré, Boulogne-Billancourt, France
  21. 21 St. Elizabeth’s Medical Center, Boston, Massachusetts, USA
  22. 22 Department of Rheumatology, First Faculty of Medicine, Charles University of Prague, Prague, Czech Republic
  23. 23 Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
  24. 24 Department of Rheumatology, University of California, Los Angeles, California, USA
  25. 25 Diagnostic Centre Region Hospital Silkeborg, Silkeborg, Denmark
  26. 26 Department of Rheumatology, Odense University Hospital, Odense, Denmark
  27. 27 Asklepios Medical Center, Bad Abbach, Germany
  28. 28 Southend University Hospital NHS Foundation Trust & Anglia Ruskin University, Southend-on-Sea, UK
  29. 29 Medical Centre for Rheumatology, Immanuel Krankenhaus Berlin, Berlin, Germany
  1. Correspondence to Dr Christina Duftner; christina.duftner{at}


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.

  • giant cell arteritis
  • ultrasonography
  • systemic vasculitis

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  • SC and CDu contributed equally.

  • Contributors WAS, CDe, CDu and SC designed the study. CDe and CDu organised the Delphi exercise. WAS and SC organised the web-based exercise. SC build the database, collected all images and selected the study images. SC was responsible for data entry and data precession together with CAS, GC and SR who did the statistical analyses. WAS, CDu and SC wrote the manuscript. All authors contributed to the acquisition of data and have read and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval for the web-based exercise was obtained from the Data Agency of the Southwest Hospital in Esbjerg, Denmark.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are not additional unpublished data from the study.

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