Abstract：
OBJECTIVE: Permanent visual impairment is a major complication of giant cell arteritis (GCA). We investigated the added value of color Doppler imaging (CDI) of the central retinal artery (CRA) in patients with suspected GCA for early risk evaluation before temporal artery biopsy (TAB) results become available.
METHODS: We conducted a non-interventional observational study of 30 consecutive patients hospitalized for suspected GCA, including a comprehensive analysis of clinical, laboratory, imaging, CDI and pathology data. GCA was diagnosed or excluded (GCA+, GCA-, respectively) according to American College of Rheumatology (ACR) criteria and TAB findings. Three patients not meeting ACR criteria were excluded secondarily. The GCA- group contained ten patients, and the GCA+ group contained 17 patients, including eight with unilateral, transient or permanent clinical visual impairment (CVI).
RESULTS: Mean blood flow velocity (mBFV) in the CRA was impaired in the affected eyes of GCA + CVI+ patients (1.9 ± 0.9 cm.s-1, p < 0.001) relative to controls (4.1 ± 1.0 cm.s-1), GCA- patients (3.6 ± 0.7 cm.s-1) and GCA + CVI- patients (3.8 ± 0.8 cm.s-1). The mBFVs of the CRA was similar for affected and fellow eyes (right or left). CRA mBFV measurements effectively differentiated between patients with and without CVI (ROC-curve analysis, AUC = 0.925 [95%CI: 0.700 to 0.996], p < 0.0001, 88% sensitivity, 89% specificity, and cutoff of ≤2.7 cm.s-1 for affected eyes; 75% sensitivity, 100% specificity and cutoff of ≤2.2 cm.s-1 for fellow eyes).
CONCLUSIONS: CDI facilities the early detection of visual ischemia risk in GCA+ patients, justifying urgent high-dose corticosteroid administration to save at least the fellow eye before pathology results become available.
METHODS: We conducted a non-interventional observational study of 30 consecutive patients hospitalized for suspected GCA, including a comprehensive analysis of clinical, laboratory, imaging, CDI and pathology data. GCA was diagnosed or excluded (GCA+, GCA-, respectively) according to American College of Rheumatology (ACR) criteria and TAB findings. Three patients not meeting ACR criteria were excluded secondarily. The GCA- group contained ten patients, and the GCA+ group contained 17 patients, including eight with unilateral, transient or permanent clinical visual impairment (CVI).
RESULTS: Mean blood flow velocity (mBFV) in the CRA was impaired in the affected eyes of GCA + CVI+ patients (1.9 ± 0.9 cm.s-1, p < 0.001) relative to controls (4.1 ± 1.0 cm.s-1), GCA- patients (3.6 ± 0.7 cm.s-1) and GCA + CVI- patients (3.8 ± 0.8 cm.s-1). The mBFVs of the CRA was similar for affected and fellow eyes (right or left). CRA mBFV measurements effectively differentiated between patients with and without CVI (ROC-curve analysis, AUC = 0.925 [95%CI: 0.700 to 0.996], p < 0.0001, 88% sensitivity, 89% specificity, and cutoff of ≤2.7 cm.s-1 for affected eyes; 75% sensitivity, 100% specificity and cutoff of ≤2.2 cm.s-1 for fellow eyes).
CONCLUSIONS: CDI facilities the early detection of visual ischemia risk in GCA+ patients, justifying urgent high-dose corticosteroid administration to save at least the fellow eye before pathology results become available.
摘要：
目的：永久性视力障碍是巨细胞动脉炎（GCA）的主要并发症。我们调查了可疑GCA患者视网膜中央动脉（CRA）的彩色多普勒成像（CDI）的附加值，以在颞动脉活检（TAB）结果可用之前进行早期风险评估。
方法：我们对30例因怀疑GCA而住院的连续患者进行了一项非干预性观察性研究，包括全面的临床分析，实验室,成像,CDI和病理资料。GCA被诊断或排除（GCA+，GCA-,分别）根据美国风湿病学会（ACR）标准和TAB发现。不符合ACR标准的三名患者被二次排除。GCA组包含10名患者，GCA+组包含17名患者，包括八个单方面的，短暂性或永久性临床视力障碍（CVI）。
结果：在GCACVI患者的受累眼中，CRA的平均血流速度（mBFV）受损（1.9±0.9cm。s-0.1，p<0.001）相对于对照组（4.1±1.0cm。s-1),GCA-患者（3.6±0.7cm。s-1）和GCA+CVI-患者（3.8±0.8cm。s-1).CRA的mBFV对于受影响的和同侧的眼睛(右或左)是相似的。CRAmBFV测量有效区分有和没有CVI的患者(ROC曲线分析，AUC=0.925[95CI：0.700至0.996]，p<0.0001,88%灵敏度,89%的特异性，和≤2.7厘米的截止。s-1适用于受影响的眼睛；75%的敏感度，100%特异性和≤2.2cm的截止值。s-1代表同伴的眼睛）。
结论：CDI有助于GCA+患者视觉缺血风险的早期检测，在获得病理结果之前，证明紧急大剂量皮质类固醇给药是合理的，以挽救至少另一只眼睛。
方法：我们对30例因怀疑GCA而住院的连续患者进行了一项非干预性观察性研究，包括全面的临床分析，实验室,成像,CDI和病理资料。GCA被诊断或排除（GCA+，GCA-,分别）根据美国风湿病学会（ACR）标准和TAB发现。不符合ACR标准的三名患者被二次排除。GCA组包含10名患者，GCA+组包含17名患者，包括八个单方面的，短暂性或永久性临床视力障碍（CVI）。
结果：在GCACVI患者的受累眼中，CRA的平均血流速度（mBFV）受损（1.9±0.9cm。s-0.1，p<0.001）相对于对照组（4.1±1.0cm。s-1),GCA-患者（3.6±0.7cm。s-1）和GCA+CVI-患者（3.8±0.8cm。s-1).CRA的mBFV对于受影响的和同侧的眼睛(右或左)是相似的。CRAmBFV测量有效区分有和没有CVI的患者(ROC曲线分析，AUC=0.925[95CI：0.700至0.996]，p<0.0001,88%灵敏度,89%的特异性，和≤2.7厘米的截止。s-1适用于受影响的眼睛；75%的敏感度，100%特异性和≤2.2cm的截止值。s-1代表同伴的眼睛）。
结论：CDI有助于GCA+患者视觉缺血风险的早期检测，在获得病理结果之前，证明紧急大剂量皮质类固醇给药是合理的，以挽救至少另一只眼睛。
