Table 1

Statements on definitions (n=8) and conduction (n=1) of ultrasound (US) elementary appearances in large vessel vasculitis agreed upon through a Delphi survey

DomainDefinitionAgreement (%)Delphi round
US appearance of
 normal temporal arteriesPulsating, 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.95.71
 normal extracranial large arteriesPulsating, 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.1001
 arteriosclerotic arteriesHeterogeneous and in part hyperechoic, irregularly delineated and eccentric vessel wall alteration.95.82
 ‘halo’ signHomogenous, hypoechoic wall thickening, well delineated towards the luminal side, visible both in longitudinal and transverse planes, most commonly concentric in transverse scans.91.32
 stenosis in temporal arteriesA 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
 stenosis in extracranial large arteriesTypical vasculitic vessel wall thickening with characteristic Doppler curves showing turbulence and increased systolic and diastolic blood flow velocities.751
 occlusionAbsence of colour Doppler signals in a visible artery filled with hypoechoic material, even with low pulse repetition frequency and high colour gain.87.51
 ‘compression’ sign of temporal arteriesThe thickened arterial wall remains visible upon compression; the hypoechogenic vasculitic vessel wall thickening contrasts with the mid-echogenic to hyperechogenic surrounding tissue.78.31
US assessment of
 ‘compression’ sign of temporal arteriesThe 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.91.31
  • *The term ‘midechoic’ is equivalent to the term ‘isoechoic’.