Definitions and online reliability assessment of elementary ultrasound lesions in Takayasu arteritis: a study from the OMERACT Ultrasound Working Group

Alessandro Tomelleri; Simon J Reider; Christian Dejaco; Wolfgang A Schmidt; Cristina Ponte; Alojzija Hocevar; Ana Filipa Águeda; Fatma Alibaz-Oner; Simone Appenzeller; Markus Aschwanden; Hans Bastian; Philipp Bosch; Dario Camellino; Vincent Casteleyn; Stavros Chrysidis; Thomas Daikeler; Eugenio De Miguel; Andreas P Diamantopoulos; Georgios Filippou; Ruchika Goel; Petra Hanova; Wolfgang Hartung; Kei Ikeda; Nevsun Inanc; Sandrine Jousse-Joulin; Aaron Juche; Rositsa Karalilova; Kresten Krarup Keller; Søren Geill Kjær; Minna J Kohler; Matthew J Koster; Pierluigi Macchioni; Sarah L Mackie; Marcin Milchert; Durga Prasanna Misra; Juan Molina-Collada; Sara Monti; Daiki Nakagomi; Esperanza Naredo; Berit Dalsgaard Nielsen; Michihiro Ogasawara; Johannes Roth; Valentin S Schäfer; Luca Seitz; Pascal Seitz; Russka Shumnalieva; Lene Terslev; Kornelis S M van der Geest; Florentin Ananu Vreju; Maria-Antonietta D'Agostino; Helen I Keen; Peter Mandl; Carlos Pineda; Christina Duftner; Milena Bond

doi:10.1016/j.semarthrit.2026.152927

Definitions and online reliability assessment of elementary ultrasound lesions in Takayasu arteritis: a study from the OMERACT Ultrasound Working Group

Alessandro Tomelleri
, Simon J Reider
, Christian Dejaco
, Wolfgang A Schmidt
, Cristina Ponte
, Alojzija Hocevar
, Ana Filipa Águeda
, Fatma Alibaz-Oner
, Simone Appenzeller
, Markus Aschwanden
, Hans Bastian
, Philipp Bosch
, Dario Camellino
, Vincent Casteleyn
, Stavros Chrysidis
, Thomas Daikeler
, Eugenio De Miguel
, Andreas P Diamantopoulos
, Georgios Filippou
, Ruchika Goel

Petra Hanova, Wolfgang Hartung, Kei Ikeda, Nevsun Inanc, Sandrine Jousse-Joulin, Aaron Juche, Rositsa Karalilova, Kresten Krarup Keller, Søren Geill Kjær, Minna J Kohler, Matthew J Koster, Pierluigi Macchioni, Sarah L Mackie, Marcin Milchert, Durga Prasanna Misra, Juan Molina-Collada, Sara Monti, Daiki Nakagomi, Esperanza Naredo, Berit Dalsgaard Nielsen, Michihiro Ogasawara, Johannes Roth, Valentin S Schäfer, Luca Seitz, Pascal Seitz, Russka Shumnalieva, Lene Terslev, Kornelis S M van der Geest, Florentin Ananu Vreju, Maria-Antonietta D'Agostino, Helen I Keen, Peter Mandl, Carlos Pineda, Christina Duftner, Milena Bond

Krankenhaus Bruneck

Research output: Contribution to journal › Original Article › peer-review

Abstract

OBJECTIVES: Reliable tools for monitoring disease activity in Takayasu arteritis (TAK) are lacking, and ultrasonography (US) may represent a valuable option. This study aimed to: 1) develop consensus-based definitions for key US lesions in TAK; 2) identify the relevant arterial segments to include in an US-based score; 3) assess inter- and intra-rater reliability of the definitions in a web-based image analysis and scoring exercise.

METHODS: A Delphi survey was conducted among members of the OMERACT Ultrasound Working Group to agree upon the definitions of key elementary US lesions and arterial segments to be included. A subsequent web-based reliability exercise included US images from TAK patients and healthy controls depicting the consensual lesions. Experts scored each image in two separate rounds. Inter-rater and intra-rater reliability were assessed using Fleiss' and Cohen's kappa (κ), respectively.

RESULTS: Three Delphi rounds were completed with 47, 46, and 43 experts respectively. Consensus was reached on three lesions ('macaroni sign', stenosis, occlusion) and seven arterial segments (bilateral common carotid, subclavian, axillary arteries, abdominal aorta). Forty-five experts completed the reliability exercise. Inter-rater reliability was moderate to good (κ = 0.47-0.64), with the highest agreement for the 'macaroni sign' in the carotid artery (κ = 0.73). Intra-rater reliability was good (κ = 0.72-0.79), with lower agreement for stenosis and occlusion in the abdominal aorta.

CONCLUSIONS: This OMERACT initiative established consensus-based definitions for US lesions in TAK and identified key relevant arterial segments, providing a reliable basis for the development of a standardized US composite score.

Original language	English
Pages (from-to)	152927
Journal	SEMINARS IN ARTHRITIS AND RHEUMATISM
Volume	77
DOIs	https://doi.org/10.1016/j.semarthrit.2026.152927
Publication status	E-pub ahead of print - 25 Jan 2026

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10.1016/j.semarthrit.2026.152927

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Tomelleri, A., Reider, S. J., Dejaco, C., Schmidt, W. A., Ponte, C., Hocevar, A., Águeda, A. F., Alibaz-Oner, F., Appenzeller, S., Aschwanden, M., Bastian, H., Bosch, P., Camellino, D., Casteleyn, V., Chrysidis, S., Daikeler, T., De Miguel, E., Diamantopoulos, A. P., Filippou, G., ... Bond, M. (2026). Definitions and online reliability assessment of elementary ultrasound lesions in Takayasu arteritis: a study from the OMERACT Ultrasound Working Group. SEMINARS IN ARTHRITIS AND RHEUMATISM, 77, 152927. Advance online publication. https://doi.org/10.1016/j.semarthrit.2026.152927

@article{8c6fb282b93a410f91a5f21111622379,

title = "Definitions and online reliability assessment of elementary ultrasound lesions in Takayasu arteritis: a study from the OMERACT Ultrasound Working Group",

abstract = "OBJECTIVES: Reliable tools for monitoring disease activity in Takayasu arteritis (TAK) are lacking, and ultrasonography (US) may represent a valuable option. This study aimed to: 1) develop consensus-based definitions for key US lesions in TAK; 2) identify the relevant arterial segments to include in an US-based score; 3) assess inter- and intra-rater reliability of the definitions in a web-based image analysis and scoring exercise.METHODS: A Delphi survey was conducted among members of the OMERACT Ultrasound Working Group to agree upon the definitions of key elementary US lesions and arterial segments to be included. A subsequent web-based reliability exercise included US images from TAK patients and healthy controls depicting the consensual lesions. Experts scored each image in two separate rounds. Inter-rater and intra-rater reliability were assessed using Fleiss' and Cohen's kappa (κ), respectively.RESULTS: Three Delphi rounds were completed with 47, 46, and 43 experts respectively. Consensus was reached on three lesions ('macaroni sign', stenosis, occlusion) and seven arterial segments (bilateral common carotid, subclavian, axillary arteries, abdominal aorta). Forty-five experts completed the reliability exercise. Inter-rater reliability was moderate to good (κ = 0.47-0.64), with the highest agreement for the 'macaroni sign' in the carotid artery (κ = 0.73). Intra-rater reliability was good (κ = 0.72-0.79), with lower agreement for stenosis and occlusion in the abdominal aorta.CONCLUSIONS: This OMERACT initiative established consensus-based definitions for US lesions in TAK and identified key relevant arterial segments, providing a reliable basis for the development of a standardized US composite score.",

author = "Alessandro Tomelleri and Reider, \{Simon J\} and Christian Dejaco and Schmidt, \{Wolfgang A\} and Cristina Ponte and Alojzija Hocevar and {\'A}gueda, \{Ana Filipa\} and Fatma Alibaz-Oner and Simone Appenzeller and Markus Aschwanden and Hans Bastian and Philipp Bosch and Dario Camellino and Vincent Casteleyn and Stavros Chrysidis and Thomas Daikeler and \{De Miguel\}, Eugenio and Diamantopoulos, \{Andreas P\} and Georgios Filippou and Ruchika Goel and Petra Hanova and Wolfgang Hartung and Kei Ikeda and Nevsun Inanc and Sandrine Jousse-Joulin and Aaron Juche and Rositsa Karalilova and Keller, \{Kresten Krarup\} and Kj{\ae}r, \{S{\o}ren Geill\} and Kohler, \{Minna J\} and Koster, \{Matthew J\} and Pierluigi Macchioni and Mackie, \{Sarah L\} and Marcin Milchert and Misra, \{Durga Prasanna\} and Juan Molina-Collada and Sara Monti and Daiki Nakagomi and Esperanza Naredo and Nielsen, \{Berit Dalsgaard\} and Michihiro Ogasawara and Johannes Roth and Sch{\"a}fer, \{Valentin S\} and Luca Seitz and Pascal Seitz and Russka Shumnalieva and Lene Terslev and \{van der Geest\}, \{Kornelis S M\} and Vreju, \{Florentin Ananu\} and Maria-Antonietta D'Agostino and Keen, \{Helen I\} and Peter Mandl and Carlos Pineda and Christina Duftner and Milena Bond",

note = "Copyright {\textcopyright} 2026. Published by Elsevier Inc.",

year = "2026",

month = jan,

day = "25",

doi = "10.1016/j.semarthrit.2026.152927",

language = "English",

volume = "77",

pages = "152927",

journal = "SEMINARS IN ARTHRITIS AND RHEUMATISM",

issn = "0049-0172",

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Tomelleri, A, Reider, SJ, Dejaco, C, Schmidt, WA, Ponte, C, Hocevar, A, Águeda, AF, Alibaz-Oner, F, Appenzeller, S, Aschwanden, M, Bastian, H, Bosch, P, Camellino, D, Casteleyn, V, Chrysidis, S, Daikeler, T, De Miguel, E, Diamantopoulos, AP, Filippou, G, Goel, R, Hanova, P, Hartung, W, Ikeda, K, Inanc, N, Jousse-Joulin, S, Juche, A, Karalilova, R, Keller, KK, Kjær, SG, Kohler, MJ, Koster, MJ, Macchioni, P, Mackie, SL, Milchert, M, Misra, DP, Molina-Collada, J, Monti, S, Nakagomi, D, Naredo, E, Nielsen, BD, Ogasawara, M, Roth, J, Schäfer, VS, Seitz, L, Seitz, P, Shumnalieva, R, Terslev, L, van der Geest, KSM, Vreju, FA, D'Agostino, M-A, Keen, HI, Mandl, P, Pineda, C, Duftner, C & Bond, M 2026, 'Definitions and online reliability assessment of elementary ultrasound lesions in Takayasu arteritis: a study from the OMERACT Ultrasound Working Group', SEMINARS IN ARTHRITIS AND RHEUMATISM, vol. 77, pp. 152927. https://doi.org/10.1016/j.semarthrit.2026.152927

Definitions and online reliability assessment of elementary ultrasound lesions in Takayasu arteritis: a study from the OMERACT Ultrasound Working Group. / Tomelleri, Alessandro; Reider, Simon J; Dejaco, Christian et al.
In: SEMINARS IN ARTHRITIS AND RHEUMATISM, Vol. 77, 25.01.2026, p. 152927.

Research output: Contribution to journal › Original Article › peer-review

TY - JOUR

T1 - Definitions and online reliability assessment of elementary ultrasound lesions in Takayasu arteritis

T2 - a study from the OMERACT Ultrasound Working Group

AU - Tomelleri, Alessandro

AU - Reider, Simon J

AU - Dejaco, Christian

AU - Schmidt, Wolfgang A

AU - Ponte, Cristina

AU - Hocevar, Alojzija

AU - Águeda, Ana Filipa

AU - Alibaz-Oner, Fatma

AU - Appenzeller, Simone

AU - Aschwanden, Markus

AU - Bastian, Hans

AU - Bosch, Philipp

AU - Camellino, Dario

AU - Casteleyn, Vincent

AU - Chrysidis, Stavros

AU - Daikeler, Thomas

AU - De Miguel, Eugenio

AU - Diamantopoulos, Andreas P

AU - Filippou, Georgios

AU - Goel, Ruchika

AU - Hanova, Petra

AU - Hartung, Wolfgang

AU - Ikeda, Kei

AU - Inanc, Nevsun

AU - Jousse-Joulin, Sandrine

AU - Juche, Aaron

AU - Karalilova, Rositsa

AU - Keller, Kresten Krarup

AU - Kjær, Søren Geill

AU - Kohler, Minna J

AU - Koster, Matthew J

AU - Macchioni, Pierluigi

AU - Mackie, Sarah L

AU - Milchert, Marcin

AU - Misra, Durga Prasanna

AU - Molina-Collada, Juan

AU - Monti, Sara

AU - Nakagomi, Daiki

AU - Naredo, Esperanza

AU - Nielsen, Berit Dalsgaard

AU - Ogasawara, Michihiro

AU - Roth, Johannes

AU - Schäfer, Valentin S

AU - Seitz, Luca

AU - Seitz, Pascal

AU - Shumnalieva, Russka

AU - Terslev, Lene

AU - van der Geest, Kornelis S M

AU - Vreju, Florentin Ananu

AU - D'Agostino, Maria-Antonietta

AU - Keen, Helen I

AU - Mandl, Peter

AU - Pineda, Carlos

AU - Duftner, Christina

AU - Bond, Milena

PY - 2026/1/25

Y1 - 2026/1/25

N2 - OBJECTIVES: Reliable tools for monitoring disease activity in Takayasu arteritis (TAK) are lacking, and ultrasonography (US) may represent a valuable option. This study aimed to: 1) develop consensus-based definitions for key US lesions in TAK; 2) identify the relevant arterial segments to include in an US-based score; 3) assess inter- and intra-rater reliability of the definitions in a web-based image analysis and scoring exercise.METHODS: A Delphi survey was conducted among members of the OMERACT Ultrasound Working Group to agree upon the definitions of key elementary US lesions and arterial segments to be included. A subsequent web-based reliability exercise included US images from TAK patients and healthy controls depicting the consensual lesions. Experts scored each image in two separate rounds. Inter-rater and intra-rater reliability were assessed using Fleiss' and Cohen's kappa (κ), respectively.RESULTS: Three Delphi rounds were completed with 47, 46, and 43 experts respectively. Consensus was reached on three lesions ('macaroni sign', stenosis, occlusion) and seven arterial segments (bilateral common carotid, subclavian, axillary arteries, abdominal aorta). Forty-five experts completed the reliability exercise. Inter-rater reliability was moderate to good (κ = 0.47-0.64), with the highest agreement for the 'macaroni sign' in the carotid artery (κ = 0.73). Intra-rater reliability was good (κ = 0.72-0.79), with lower agreement for stenosis and occlusion in the abdominal aorta.CONCLUSIONS: This OMERACT initiative established consensus-based definitions for US lesions in TAK and identified key relevant arterial segments, providing a reliable basis for the development of a standardized US composite score.

AB - OBJECTIVES: Reliable tools for monitoring disease activity in Takayasu arteritis (TAK) are lacking, and ultrasonography (US) may represent a valuable option. This study aimed to: 1) develop consensus-based definitions for key US lesions in TAK; 2) identify the relevant arterial segments to include in an US-based score; 3) assess inter- and intra-rater reliability of the definitions in a web-based image analysis and scoring exercise.METHODS: A Delphi survey was conducted among members of the OMERACT Ultrasound Working Group to agree upon the definitions of key elementary US lesions and arterial segments to be included. A subsequent web-based reliability exercise included US images from TAK patients and healthy controls depicting the consensual lesions. Experts scored each image in two separate rounds. Inter-rater and intra-rater reliability were assessed using Fleiss' and Cohen's kappa (κ), respectively.RESULTS: Three Delphi rounds were completed with 47, 46, and 43 experts respectively. Consensus was reached on three lesions ('macaroni sign', stenosis, occlusion) and seven arterial segments (bilateral common carotid, subclavian, axillary arteries, abdominal aorta). Forty-five experts completed the reliability exercise. Inter-rater reliability was moderate to good (κ = 0.47-0.64), with the highest agreement for the 'macaroni sign' in the carotid artery (κ = 0.73). Intra-rater reliability was good (κ = 0.72-0.79), with lower agreement for stenosis and occlusion in the abdominal aorta.CONCLUSIONS: This OMERACT initiative established consensus-based definitions for US lesions in TAK and identified key relevant arterial segments, providing a reliable basis for the development of a standardized US composite score.

U2 - 10.1016/j.semarthrit.2026.152927

DO - 10.1016/j.semarthrit.2026.152927

M3 - Original Article

C2 - 41702323

SN - 0049-0172

VL - 77

SP - 152927

JO - SEMINARS IN ARTHRITIS AND RHEUMATISM

JF - SEMINARS IN ARTHRITIS AND RHEUMATISM

ER -

Definitions and online reliability assessment of elementary ultrasound lesions in Takayasu arteritis: a study from the OMERACT Ultrasound Working Group

Abstract

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