Key result
Frontal-branch ultrasound IMT of ≥0.28 mm linked to ~43-fold higher odds of giant cell arteritis.
Why the study?
The diagnostic accuracy, reproducibility, and acquisition time of focused bilateral frontal-branch ultrasonography based on intima-media thickness in suspected giant cell arteritis were not established.
Does focused bilateral frontal-branch ultrasonography provide accurate and time-efficient diagnostic assessment in patients with suspected giant cell arteritis?
Cohort (n=171)
Blinded assessors
No
Does focused bilateral frontal-branch ultrasonography provide accurate and time-efficient diagnostic assessment in patients with suspected giant cell arteritis?
Odds Ratio: 43 (95% CI 10.5–175.8)
p-value: p=<0.001
Focused bilateral frontal-branch ultrasonography provides a rapid and highly specific initial cranial assessment for giant cell arteritis, reducing examination time compared to complete temporal artery protocols.
May support focused frontal-branch IMT as rapid, specific initial GCA test; extends ultrasonographic data but leaves open multicenter validation.
OBJECTIVE: To evaluate the diagnostic accuracy, reproducibility, and acquisition time of focused bilateral frontal-branch ultrasonography based on intima-media thickness (IMT) in suspected giant cell arteritis (GCA). METHODS: In this prospective single-center study, 171 patients underwent color Doppler ultrasonography of the temporal and large arteries and ultrasonography-guided temporal artery biopsy. Bilateral mean frontal-branch IMT was evaluated against the expert diagnosis established at six months. Diagnostic performance was assessed using ROC analysis and multivariable logistic regression. Reproducibility was assessed in 100 randomly selected images. RESULTS: GCA was diagnosed in 107 patients, including 96 biopsy-positive cases. Mean frontal-branch IMT had the highest observed area under the curve among the temporal artery segments (0.87). At the 0.28-mm cutoff, sensitivity was 71%, specificity 94%, LR+ 11.4, and LR- 0.31. Frontal IMT ≥ 0.28 mm was the strongest independent predictor of GCA (odds ratio 43.0). At a cutoff of ≥3, the exploratory PAMELA (Performance Analysis of a Monosegmental Ultrasonographic Evaluation of the Frontal-Branch of the Superficial Temporal Artery in Giant Cell Arteritis) score had a sensitivity of 74.8% and specificity of 93.7%. Focused bilateral frontal-branch assessment required 1.07 ± 0.24 minutes versus 7.62 ± 1.11 minutes for the complete temporal artery protocol. Intraobserver and interobserver intraclass correlation coefficients were 0.96 and 0.93. CONCLUSION: Focused bilateral frontal-branch ultrasonography provides a highly specific, reproducible, and time-efficient initial cranial assessment in suspected GCA. However, the 0.28-mm cutoff and PAMELA score require external validation, and the remaining temporal and large-vessel territories should be examined when frontal findings are negative or equivocal.
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Germanò et al. (2026) conducted a cohort in Suspected giant cell arteritis (GCA) (n=171). Focused bilateral frontal-branch ultrasonography vs. Expert clinical diagnosis at six months / Complete temporal artery ultrasonography protocol was evaluated on Final clinical diagnosis of GCA at six months predicted by frontal IMT ≥ 0.28 mm (OR 43.0, 95% CI 10.5-175.8, p=<0.001). Focused bilateral frontal-branch ultrasonography with an IMT cutoff of ≥0.28 mm strongly and independently predicted giant cell arteritis with an OR of 43.0, achieving 71% sensitivity and 94% specificity.
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