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Imaging in vasculitis
Orrin M Troum1, Olga L Pimienta1, Alvin Wells2
1Providence St. John's Health Center, Department of Rheumatology, Santa Monica, California.
Insights
Imaging is crucial for diagnosing and monitoring vasculitis, a condition involving blood vessel inflammation. Advanced techniques like PET scans offer high accuracy, aiding early detection and treatment planning for various vasculitis types.
Area of Science:
- Rheumatology
- Radiology
- Internal Medicine
Background:
- Systemic vasculitides involve blood vessel inflammation, classified by vessel size (large, medium, small).
- Early diagnosis and monitoring of vasculitis are vital for effective treatment and preventing complications.
Purpose of the Study:
- To review current imaging modalities used in the diagnosis and monitoring of vasculitis.
- To highlight the increasing importance of imaging in managing vasculitis.
Main Methods:
- Review of recent literature and guidelines (2021 ACR, 2023 EULAR).
- Discussion of various imaging techniques: ultrasonography (US), MRI, MRA, CT, CTA, and FDG-PET/CT.
- Focus on advancements in PET imaging for large vessel vasculitis.
Main Results:
- Recent guidelines (ACR, EULAR) emphasize imaging's role in vasculitis evaluation.
- FDG-PET/CT shows high sensitivity and specificity for detecting temporal arteritis.
- Advances in PET imaging include improved acquisition and novel radiotracers.
Conclusions:
- Imaging is integral to vasculitis diagnosis and monitoring, with growing clinical significance.
- Guidelines differ: ACR favors biopsy, EULAR favors imaging for large vessel vasculitis (LVV) initial evaluation.
- Effective use of imaging requires skilled interpreters and cost-effectiveness.
Purpose Of Review:
Systemic vasculitides are characterized by inflammation of blood vessels. Their classification is based on the size of the blood vessels involved - large, medium, or small. Vasculitis early diagnosis and reliable monitoring are crucial to establish a treatment plan and prevent serious complications. Based on these considerations and depending on the location of the affected vessels, the importance of imaging modalities including ultrasonography (US), magnetic resonance Imaging (MRI), magnetic resonance angiography (MRA), computed tomography (CT), computed tomography angiography (CTA), and [18F]-fluoro-2-deoxy- d -glucose positron emission tomography/computed tomography (FDG-PET/CT) has progressively increased. In addition to physical exam and laboratory data, these imaging tools offer complementary information about vascular changes occurring in vasculitis.This review summarizes the different imaging modalities being utilized to diagnose and monitor vasculitis.
Recent Findings:
The most recent update for the use of imaging in vasculitis is referenced in the 2023 European Alliance of Associations for Rheumatology (EULAR) recommendations and the American College of Rheumatology (ACR) guidelines in 2021. Recent advances in PET imaging in large vessel vasculitis include improved technological imaging acquisition and the use of novel radiotracers for cellular and immune targets. FDG-PET has now been demonstrated to have high sensitivity and specificity to detect temporal arteritis.
Summary:
Imaging plays a significant role in the evaluation of vasculitis and continues to gain importance in the diagnosis and monitoring of disease activity. Differences exist between the ACR guidelines, which advocates for temporal artery biopsy, and the EULAR guidelines, which favors imaging modalities for the initial evaluation and diagnosis of large vessel vasculitis (LVV). Prerequisites for appropriate clinical management utilizing imaging in patients with vasculitis are the availability and access to skilled clinicians to interpret the images and the cost of these techniques not being prohibitive.
