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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (6): 1128-1133. doi: 10.19723/j.issn.1671-167X.2022.06.012

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Comparison of diagnostic efficacy of different classification criteria for Takayasu arteritis in Chinese patients

Rui-jie CAO1,2,Zhong-qiang YAO1,Peng-qing JIAO2,Li-gang CUI3,*()   

  1. 1. Department of Rheumatology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Rheumato-logy, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
    3. Department of Ultrasound Medicine, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-09-01 Online:2022-12-18 Published:2022-12-19
  • Contact: Li-gang CUI E-mail:cuijuegang@126.com
  • Supported by:
    National Natural Science Foundation of China(8207071016)

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Abstract:

Objective: To compare the diagnostic efficiency of the 1990 American College of Rheumatology (ACR) classification criteria for Takayasu arteritis (TA) and the 2022 ACR classification criteria for TA in Chinese populations. Methods: The clinical and imaging data of TA patients and patients with arterial stenosis or occlusion caused by atherosclerosis who were admitted to Peking University Third Hospital from May 2012 to May 2022 were retrospectively analyzed. Clinical diagnosis of TA by two rheumatologists were defined as the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and the area under the receiver operating characteristics (ROC) curve (AUC) of the above two classification criteria were compared. In addition, this study also attempted to apply new imaging modalities, such as color Doppler ultrasound (CDUS), computed tomography angiography (CTA), magnetic resonance angiography (MRA) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in the 1990 ACR classification criteria to find whether this approach would improve the diagnostic efficiency. At the same time, the imaging features of the two groups were compared. Results: The sensitivity (91.75%), positive predictive value (94.68%), negative predictive value (92.79%), accuracy (93.66%) and AUC (0.979) of the 2022 ACR TA classification criteria were better than those of the 1990 ACR TA classification criteria (45.36%, 91.67%, 66.24%, 72.20% and 0.855, respectively). In addition, we included new imaging modalities, such as CDUS, CTA, MRA and PET/CT in the 1990 ACR TA classification criteria, and the sensitivity, positive predictive value, negative predictive value, accuracy and AUC were significantly improved, which were 63.92%, 92.54%, 74.64%, 80.49% and 0.959, respectively, but still lower than those of the 2022 ACR classification criteria of TA (P < 0.001). The TA patients had more arterial stenosis (P=0.030), while the atherosclerosis patients had more arterial occlusion (P=0.021). There was no significant difference in arterial aneurysm or dissection (P=0.171). The TA patients had more involvement of ≥3 arteries (P=0.013), while the atherosclerosis patients had more unique artery involvement (P=0.011). Conclusion: Compared with the 1990 ACR classification criteria for TA, the 2022 ACR classification criteria had higher diagnostic efficiency and might be more sui-table for the Chinese populations. Using more imaging modalities would improve the diagnostic perfor-mance of 1990 ACR classification criteria.

Key words: Takayasu arteritis, Diagnosis, Sensitivity and specificity, China

CLC Number: 

  • R593.2

Table 1

Comparison of demographic and clinical characteristics between the two groups[n(%)]"

Items Takayasu's arteritis
(n=97)		 Atherosclerosis
(n=108)		 χ2/Z P values
Female 85 (87.63) 24 (22.22) 87.800 < 0.001
Age at diagnosis
    < 40 years 71 (73.20) 9 (8.33) 90.352 < 0.001
   40-60 years 21 (21.65) 83 (76.85) 62.303 < 0.001
   >60 years 5 (5.15) 16 (14.81) 5.187 0.023
Clinical symptoms
   Fever 16 (16.49) 0 19.323 < 0.001
   Weakness 30 (30.93) 3 (2.78) 29.982 < 0.001
   Limb claudication 23 (23.71) 54 (50.00) 15.059 < 0.001
   Headache/Dizziness 43 (44.33) 28 (25.93) 7.646 0.006
   Sudden blindness/ Visual disturbance 12 (12.37) 7 (6.48) 2.108 0.147
Clinical signs
   Decreased or absent pulses in upper limbs 48 (49.48) 9 (8.33) 43.110 < 0.001
   Weak or tender carotid pulse 21 (21.65) 7 (6.48) 9.970 0.002
   Arterial bruit 46 (47.42) 6 (5.56) 47.315 < 0.001
   A difference of more than 10 mmHg systolic pressure between two limbs 38 (39.18) 5 (4.63) 36.792 < 0.001
   A difference of more than 20 mmHg systolic pressure between two limbs 24 (24.74) 4 (3.70) 19.180 < 0.001

Table 2

Locations of arterial involvement in Takayasu's arteritis and atherosclerosis patients [n(%)]"

Items Takayasu's arteritis (n=97) Atherosclerosis (n=108) χ2 P values
Ascending aorta 15 (15.46) 0 18.020 < 0.001
Aortic arch 23 (23.71) 0 28.844 < 0.001
Brachiocephalic trunk 26 (26.80) 0 33.153 < 0.001
Left subclavian artery 46 (47.42) 14 (12.96) 29.313 < 0.001
Right subclavian artery 43 (44.33) 11 (10.19) 30.706 < 0.001
Left common carotid artery 67 (69.07) 34 (31.48) 28.891 < 0.001
Right common carotid artery 67 (69.07) 30 (27.78) 34.957 < 0.001
Thoracic aorta 17 (17.53) 1 (0.93) 17.581 < 0.001
Abdominal aorta 29 (29.90) 19 (17.59) 4.314 0.038
Left renal artery 25 (25.77) 8 (7.41) 12.762 < 0.001
Right renal artery 23 (23.71) 9 (8.33) 9.174 0.002
Celiac trunk 7 (7.22) 2 (1.85) 2.342 0.126
Superior mesenteric artery 11 (11.34) 2 (1.85) 7.746 0.005
Left common iliac artery 4 (4.12) 20 (18.52) 10.244 0.001
Right common iliac artery 2 (2.06) 17 (15.74) 11.371 0.001
Left common femoral artery 4 (4.12) 29 (26.85) 19.545 < 0.001
Right common femoral artery 2 (2.06) 31 (28.70) 26.856 < 0.001
Paired artery involvement 72 (74.23) 60 (55.56) 7.770 0.005

Table 3

Imaging characteristics of arterial involvement in the two groups[n(%)]"

Items Takayasu's arteritis (n=97) Atherosclerosis (n=108) χ2 P values
Arterial stenosis 97 (100.0) 101 (93.5) 4.692 0.030
Arterial occlusion 33 (34.0) 54 (50.0) 5.342 0.021
Aneurysm formation or dissection 3 (3.1) 8 (7.4) 1.873 0.171
   ≥3 arteries involved 81 (83.5) 74 (68.5) 6.224 0.013
   2 arteries involved 13 (13.4) 20 (18.5) 0.990 0.320
   1 artery involved 3 (3.1) 14 (13.0) 6.546 0.011

Table 4

Comparison of evaluation indicators of different classification criteria [M(P25, P75)]"

Classification criteria for TA Sensitivity Specificity Positive predictive value Negative predictive value Accuracy AUC
1990 ACR 45.36
(35.33-55.76)		 96.30
(90.24-98.81)		 91.67
(79.13-97.30)		 66.24
(58.21-73.47)		 72.20
(65.70-77.88)		 0.855
(0.804-0.907)
Revised 1990 ACR 63.92
(53.48-73.24)		 95.37
(89.01-98.28)		 92.54
(82.74-97.22)		 74.64
(66.39-81.48)		 80.49
(74.53-85.33)		 0.959
(0.933-0.984)
2022 ACR 91.75
(83.93-96.11)		 95.37
(89.01-98.28)		 94.68
(87.45-98.03)		 92.79
(85.86-96.61)		 93.66
(89.46-96.26)		 0.979
(0.961-0.998)

Figure 1

Receiver operating characteristics (ROC) curves of different classification criteria Abbreviations as in Table 4."

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