Journal Article

EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update

Brolin, Sara, Bley, Thorsten A, Bond, Milena, Cid, Maria C, Cassie, Rebecca, Ponte, Cristina, Duftner, Christina, Schäfer, Valentin Sebastian, Slart, Riemer H J A, De Miguel, Eugenio, Molto, Anna, Ramiro, Sofia, Bosch, Philipp, Schmidt, Wolfgang A, Bolek, Ertugrul Cagri, Direskeneli, Haner, Nielsen, Berit Dalsgaard, Molina-Collada, Juan, Seitz, Luca, Mackie, Sarah Louise, Hočevar, Alojzija, Dejaco, Christian, Blockmans, Daniel, Dasgupta, Bhaskar

2024

Overview

ObjectivesTo update the EULAR recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV).MethodsA systematic literature review update was performed to retrieve new evidence on ultrasound, MRI, CT and [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis, monitoring and outcome prediction in LVV. The task force consisted of 24 physicians, health professionals and patients from 14 countries. The recommendations were updated based on evidence and expert opinion, iterating until voting indicated consensus. The level of agreement was determined by anonymous votes.ResultsThree overarching principles and eight recommendations were agreed. Compared to the 2018 version, ultrasound is now recommended as first-line imaging test in all patients with suspected giant cell arteritis, and axillary arteries should be included in the standard examination. As an alternative to ultrasound, cranial and extracranial arteries can be examined by FDG-PET or MRI. For Takayasu arteritis, MRI is the preferred imaging modality; FDG-PET, CT or ultrasound are alternatives. Although imaging is not routinely recommended for follow-up, ultrasound, FDG-PET or MRI may be used for assessing vessel abnormalities in LVV patients with suspected relapse, particularly when laboratory markers of inflammation are unreliable. MR-angiography, CT-angiography or ultrasound may be used for long-term monitoring of structural damage, particularly at sites of preceding vascular inflammation.ConclusionsThe 2023 EULAR recommendations provide up-to-date guidance for the role of imaging in the diagnosis and assessment of patients with LVV.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited
• Subject: Angiography / Arteritis / Axillary Artery - diagnostic imaging / Biopsy / Clinical medicine / Computed tomography / Diagnosis / FDA approval / Fluorodeoxyglucose F18 / Giant Cell Arteritis / Giant Cell Arteritis - diagnostic imaging / Humans / Inflammation / Literature reviews / Magnetic Resonance Imaging / Magnetic Resonance Imaging - methods / Medical imaging / Medical personnel / Patient assessment / Positron emission tomography / Positron-Emission Tomography - methods / Recommendation / Rheumatology / Takayasu Arteritis - diagnostic imaging / Takayasu's disease / Task forces / Tomography / Tomography, X-Ray Computed - methods / Ultrasonic imaging / Ultrasonography / Ultrasonography - methods / Ultrasound / Vasculitis / Vasculitis - diagnostic imaging / Veins & arteries