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Imaging in Large Vessel Vasculitides
Konstanze Guggenberger1, Thorsten Bley1
1Department of Diagnostic and Interventional Radiology, University-Hospital Würzburg, Germany.
Insights
Imaging is crucial for diagnosing and monitoring large vessel vasculitides, offering a less invasive alternative to biopsy. Current guidelines recommend imaging as the primary complementary method to clinical assessment.
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.
Background:
Large vessel vasculitides comprise primary vasculitides of large and medium-sized arteries with various clinical, laboratory and radiological presentations. Imaging has become increasingly important in the diagnosis and monitoring of large vessel vasculitides. It complements clinical and laboratory examination and displays vasculitic changes of large extra- and intracranial arteries with relatively good diagnostic reliability and a low level of invasiveness.
Method:
This review presents the most important imaging modalities and some typical imaging findings in the context of the two main forms of large vessel vasculitis, giant cell arteritis and Takayasu's arteritis, with special regard to the recently launched EULAR (The European League Against Rheumatism) recommendations on the role of imaging in patients with suspected large vessel vasculitides.
Results And Conclusion:
Color-coded duplex sonography (CCDS), magnetic resonance imaging (MRI), computed tomography (CT), and 18F-fluorodeoxyglucose positron emission tomography are today's common imaging methods in large vessel vasculitides representing a reasonable and less invasive alternative or at least a good complement to temporal artery biopsy. Today's EULAR guidelines recommend an imaging test as the first complementary method to clinical examination with CCDS as the preferred diagnostic test in suspected giant cell arteritis, MRI as the equivalent alternative in the case of inconclusive results, and MRI as the first choice in suspected Takayasu's arteritis.
Key Points:
· Imaging is a noninvasive diagnostic test for diagnosing and monitoring large vessel vasculitides and is recommended nowadays as the first complementary method to clinical examination.. · Imaging is a reasonable alternative or at least a good complement to temporal artery biopsy in the case of suspected giant cell arteritis.. · Today's EULAR guidelines recommend CCDS as the preferred diagnostic test in suspected giant cell arteritis, with MRI as an equivalent alternative in the case of inconclusive results, and MRI as the first choice in suspected Takayasu's arteritis..
Citation Format:
· Guggenberger K, Bley T. Imaging in Large Vessel Vasculitides. Fortschr Röntgenstr 2019; 191: 1083 - 1090.
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