Imaging in Large Vessel Vasculitides.

Area of Science:

• Rheumatology
• Radiology
• Internal Medicine

Background:

• Large vessel vasculitides (LVV) affect large and medium-sized arteries, presenting diverse clinical, laboratory, and radiological findings.
• Imaging plays a vital role in diagnosing and monitoring LVV, complementing clinical and laboratory evaluations.
• Imaging offers reliable visualization of vasculitic changes in large extra- and intracranial arteries with minimal invasiveness.

Purpose of the Study:

• To review key imaging modalities and findings for giant cell arteritis (GCA) and Takayasu's arteritis (TA).
• To highlight the role of imaging in LVV according to recent European League Against Rheumatism (EULAR) recommendations.

Main Methods:

• Review of current literature on imaging techniques for LVV.
• Focus on color-coded duplex sonography (CCDS), magnetic resonance imaging (MRI), computed tomography (CT), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).
• Integration of findings with the latest EULAR guidelines for LVV imaging.

Main Results:

• CCDS, MRI, CT, and FDG-PET are established imaging methods for LVV.
• These modalities serve as less invasive alternatives or complements to temporal artery biopsy.
• EULAR guidelines endorse imaging as the first complementary diagnostic step for suspected LVV.

Conclusions:

• Imaging is a noninvasive diagnostic tool for LVV, recommended as a primary complementary method to clinical examination.
• Imaging is a viable alternative or adjunct to temporal artery biopsy in suspected GCA.
• EULAR guidelines prioritize CCDS for suspected GCA (with MRI as alternative), and MRI for suspected TA.