97th DOG Annual Meeting 1999
K699
HIGHLY DISSOLVING COLOR DUPLEX SONOGRAPHY IN DIAGNOSIS OF ARTERITIS TEMPORALIS
K. Nordwald 1, S. Venz 2, R. Felix 2
Introduction: The decisive diagnosis of arteritis temporalis (M. Horton) is a positive histologic result of biopsy. But the histologic result is however never immediately available. A negativ histologic result is because of the possible segmental vessel involvement and sometimes only a short part of biopsied artery no exclusion for diagnosis of Arteritis temporalis. Due to this an additional imaging procedure would be helpful, which gives the diagnosis for arteritis temporalis to support the diagnostic security of the clinical findings already on the first day. Some earlier studies show the use of color duplex sonography.
Patients and Methods: We examined prospectively (prior to biopsy) 25 patients with suspected arteritis temporalis the temple arteries of changes in surroun-ding tissues with the help of high dissolving color duplex sonography. All 25 patients were examined with a 9-12 MHz linear array transducer with near field focus and continous dynamic receive focusing at a 'Sonoline Elegra' (Siemens AG, Berlin) and normally ophthalmologic and bioptic examination.
Results: 19 of the 25 examined patients showed on the affected eye a noticable loss of vision under 20/200. Seven of the 25 patients showed a positive histologic result of an arteritis temporalis. Only five patients had a BSR over 50mm in the first hour, and only two of these patients showed a hardening of temple vessels. At all these 7 patients we found in temporalis duplex sonography in the course of major trunk and along the R. parietalis of A. temporalis a margin with less echo of tissue. In contrast the other 16/18 patients with a negative result of biopsy showed a margin with a thicker echo of tissue. At two patients with massive arteriosclerotic vessel changes (smokers and/or hypertension for many years) we saw a long stretch margin with little echo of tissue also and didn't find any histological arteritis results.
Conclusion: It seems, that the high dissolving color duplex sonography is highly valuable for the prediction of arteritis temporalis. When more hospitals have this equipment in the future, the high dissolving color duplex sonography will be an important addition for diagnosis of arteritis temporalis. We saw false positive results in the duplex sonography. It seems, that massive arteriosclerotic vessel changes can imitate the sonographic picture of arteritis temporalis.
Eye Clinic1 and Radiologic Clinic2 Charité, Campus Virchow-Klinikum, Humboldt-University of Berlin, Augustenburger Platz 1, D - 13353 Berlin
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