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Current and Emerging Approaches to Imaging Large Vessel Vasculitis
Ahmed Tawakol1, Brittany Nicole Weber2, Michael T Osborne1
1Cardiology Division and the Cardiovascular Imaging Research Center (A.T., M.T.O., H.C.L.), Massachusetts General Hospital and Harvard Medical School, Boston.
Insights
Large vessel vasculitides (LVV), including giant cell arteritis and Takayasu arteritis, are inflammatory artery diseases. Noninvasive imaging is now essential for diagnosing LVV and monitoring arterial damage.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Radiology
Background:
- Large vessel vasculitides (LVV) are inflammatory conditions affecting major arteries like the aorta.
- Giant cell arteritis (GCA) and Takayasu arteritis (TA) are primary forms of LVV.
- Untreated LVV can cause severe complications such as blindness, stenosis, and aneurysms.
Purpose of the Study:
- To review the current applications of noninvasive vascular imaging in the diagnosis and management of LVV.
- To highlight the role of imaging in reducing the need for invasive procedures like temporal artery biopsy in GCA.
- To discuss the utility of imaging in monitoring disease activity and treatment response in LVV.
Main Methods:
- Review of current literature on noninvasive vascular imaging techniques in LVV.
- Discussion of imaging modalities including ultrasound, MRI, CT, and PET.
- Analysis of imaging's role in diagnosis, surveillance, and assessment of disease activity.
Main Results:
- Noninvasive imaging has transformed LVV management, enabling prompt diagnosis.
- Imaging techniques like ultrasound, MRI, CT, and PET are routinely used for LVV diagnosis.
- Vascular imaging aids in longitudinal surveillance and is being investigated for assessing treatment response and vascular remodeling.
Conclusions:
- Noninvasive vascular imaging is indispensable in the modern management of large vessel vasculitides.
- Imaging facilitates early detection, reduces reliance on invasive methods, and aids in long-term patient monitoring.
- Ongoing research focuses on imaging's potential to evaluate treatment efficacy and vascular changes in LVV.
Abstract:
Large vessel vasculitides (LVV) comprise a group of inflammatory disorders that involve the large arteries, such as the aorta and its primary branches. The cause of LVV is often rheumatologic and includes giant cell arteritis and Takayasu arteritis. Giant cell arteritis is the most common form of LVV affecting people >50 years of age with a slight female predominance. Takayasu arteritis is more frequently seen in younger populations and is significantly more common in women. Prompt identification of LVV is crucial as it can lead to debilitating complications if left untreated, including blindness in the case of giant cell arteritis and large artery stenosis and aneurysms in the case of all forms of LVV. Noninvasive imaging methods have greatly changed the approach to managing LVV. Today, imaging (with ultrasound, magnetic resonance imaging, computed tomography, and positron emission tomography) is routinely used in the diagnosis of LVV. In patients with giant cell arteritis, imaging often spares the use of invasive procedures such as temporal artery biopsy. In addition, vascular imaging is also crucial for longitudinal surveillance of arterial damage. Finally, imaging is currently being studied for its role in assessing treatment response and ongoing disease activity and its potential value in determining the presence of vascular wall remodeling (eg, scarring). This review explores the current uses of noninvasive vascular imaging in LVV.
