The Role of Imaging in Monitoring Large Vessel Vasculitis: A Comprehensive Review

Area of Science:

• Rheumatology
• Radiology
• Internal Medicine

Background:

• Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are primary large vessel vasculitis (LVV) impacting the aorta and its branches.
• Accurate diagnosis and monitoring are vital to prevent irreversible vascular damage.
• Current assessment methods (symptoms, exam, inflammatory markers) lack sensitivity, especially with IL-6 inhibitor use.

Purpose of the Study:

• To provide a comprehensive review of imaging's role in monitoring LVV.
• To highlight advanced imaging modalities and emerging scoring systems for LVV assessment.
• To discuss challenges and future directions in imaging for LVV management.

Main Methods:

• Narrative review of current literature on imaging in LVV.
• Evaluation of ultrasound (US), magnetic resonance imaging (MRI), and positron emission tomography (PET) for disease activity and treatment response.
• Discussion of emerging imaging indices (OMERACT GCA US Score, Takayasu US Index, TAIDAI).

Main Results:

• US, MRI, and PET offer better reflection of LVV disease activity and treatment response than clinical/lab measures.
• Emerging imaging scores show promise as treat-to-target instruments for LVV.
• CT is mainly for structural damage; conventional angiography has a limited role.

Conclusions:

• Imaging is central to a multimodal, patient-tailored approach for long-term LVV management.
• Standardization of imaging protocols and interpretation is necessary.
• Further research on imaging's prognostic value for relapse risk is warranted.