Ultrasound of giant cell arteritis
Harjit Ubhi, Leeds Biomedical Research Centre
About GCA
Giant cell arteritis (GCA) is a form of vasculitis. It affects the main arteries in the head and neck and adults over
the age of 50. GCA is commoner in women than men and is closely associated with polymyalgia rheumatica.
GCA can lead to sight loss or stroke if treatment is delayed.
In recent years new evidence has emerged with regards to diagnosis and treatment of GCA. Ultrasound is
recommended as first line imaging investigation in GCA; the inclusion of ultrasound enables the shortening of
the route to diagnosis reducing unnecessary steroid toxicity.
Ultrasound uses no radiation, is non-invasive and cost effective compared to temporal artery biopsy.
Common symptoms for referral include
• Vision disturbance
• Scalp tenderness
• Headache
• Jaw or tongue claudication
• Systemic symptoms of weight loss, loss of appetite, sweats, fatigue or malaise
Ultrasound features of GCA:
Halo sign: Presents as a hypoechoic/homogeneous concentric artery wall thickening, seen in both longitudinal
and transverse.
Compression sign: In GCA the thickened arterial wall remains visible and resistant to compression (positive
compression sign).
Tips for ultrasound practitioners wanting to learn GCA ultrasound
1. Seek a mentor that has experience in GCA ultrasound and create links with Rheumatology
2. Only provide the service as part of a multidisciplinary team
3. Increase your knowledge of GCA
4. Attend learning events i.e. GCA courses
5. Brush up on physics and knobology of Doppler ultrasound to optimise diagnostic images
6. Create a logbook to help keep a systematic record of scans you have undertaken
7. Discuss progress and obtain feedback from MDTM cases
8. Practice, Practice, Practice!
The criteria for ultrasound referral should include direct assessment and referral from specialist Rheumatology
or Ophthalmology clinicians in conjunction with the following criteria:
• Abnormal CRP (in blood sample taken before starting steroids)
• Age > 50