OP0210 FALSE POSITIVES OF ULTRASOUND IN GIANT CELL ARTERITIS. SOME DISEASES CAN ALSO HAVE HALO SIGN
Authors: Elisa Fernández, Irene Monjo, Gemma Bonilla, Chamaida Plasencia, Maria-Eugenia Miranda-Carus, Alejandro Balsa, Eugenio de Miguel
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly. The halo sign has been shown as an accepted valid test in the diagnosis of GCA in trained units<sup>1-2</sup>. However, to further improve the specificity, the sonographer should know some pathologies that can mimic halo signs since they also produce a hypoechoic increase of the arterial wall thickness. <h3>Objectives</h3> The aim of our study was to identify the causes and diseases that could be associated with the false positive diagnoses of GCA made by color Doppler ultrasound (CDUS). <h3>Methods</h3> Observational study of 305 patients with temporal artery CDUS findings compatible with GCA. The medical histories of these patients were reviewed and demographic, physical examination, clinical and analytical data were collected. The clinical diagnosis based on the long term follow-up of the patient was established as the definitive true diagnosis. <h3>Results</h3> 13 of the 305 cases included (4.3%) were false positives. The characteristics of these 13 patients and their final diagnoses are shown in table 1. 69.2% were women, while 30.8% were men. The mean age was 73.3 ± 8.0 years. Analytically, the mean ESR was 64.8 ± 42.3 mm/h, CRP 50.8 ± 60.0 mg/L and hemoglobin 12.6 ± 2.0 g/dL. Five patients (38.5%) fulfilled the ACR GCA classification criteria and eight did not (61.5%). A temporal artery biopsy was performed in 8 of the 13 patients (61.5%), with negative results in all of them. Eleven patients had CDUS involvement of superficial temporal arteries. Five had 1 branch involved (38.5%), three 2 branches (23.1%), one 3 branches (7.7%) and two 4 branches (15.4%). In addition, two patients (15.4%) had isolated halo sign in the axillary arteries, one unilateral and the other bilateral. Regarding the definitive diagnosis, four patients were polymyalgia rheumatica (30.8%), three atherosclerosis (23.1%), and there was one case of non-Hodgkin's Lymphoma type T, osteomyelitis of the skull base, primary amyloidosis associated with multiple myeloma, granulomatosis with polyangiitis, urinary sepsis and narrow-angle glaucoma. Some of these cases were false positives probably due to exam errors. However, others were due to diseases that increase the arterial wall thickness probably caused by cell infiltration and related edema (as Hodgkin's Lymphoma type T and ANCA-associated vasculitis) or by hypoechoic material deposit (as atherosclerosis and primary amyloidosis/multiple myeloma). <h3>Conclusion</h3> The percentage of false positives in the CDUS for the diagnosis of GCA is low. Nevertheless, some other diseases can also produce halo sign and the clinician should be aware of this to improve the accuracy of the ultrasound test. <h3>References</h3> [1] Chrysidis S, et al. Definitions and reliability assessment of elementary ultrasound lesions in giant cell arteritis: A study from the OMERACT large vessel vasculitis ultrasound working group. RMD Open. 2018;4(1):1–9. [2] Aranda-Valera IC, et al. Diagnostic validity of Doppler ultrasound in giant cell arteritis. Clin Exp Rheumatol. 2017;35(1):123–7. <h3>Disclosure of Interests</h3> Elisa Fernández: None declared, Irene Monjo: None declared, Gemma Bonilla: None declared, Chamaida Plasencia Speakers bureau: Pfizer, MSD, Maria-Eugenia Miranda-Carus Grant/research support from: Roche Pharma, BMS, Alejandro Balsa Grant/research support from: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Consultant for: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Sandoz, Lilly, Paid instructor for: Pfizer, Speakers bureau: Pfizer, Novartis, UCB, Nordic, Sanofi, Sandoz, Lilly, Eugenio de Miguel: None declared