Imaging for Diagnosis, Monitoring, and Outcome Prediction of Large Vessel Vasculitides
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RECENT ADVANCES IN LARGE VESSEL VASCULITIS (C DEJACO AND C DUFTNER, SECTION EDITORS)
Imaging for Diagnosis, Monitoring, and Outcome Prediction of Large Vessel Vasculitides Valentin Sebastian Schäfer 1 & Lei Jin 1 & Wolfgang Andreas Schmidt 3
# The Author(s) 2020
Abstract Purpose of Review To discuss and summarize the latest evidence on imaging techniques in giant cell arteritis (GCA) and Takayasu arteritis (TAK). This is a report on the performance of ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18-FDG-PET), and other emerging imaging techniques in diagnosis, outcome prediction, and monitoring of disease activity. Recent Findings Imaging techniques have gained an important role for diagnosis of large vessel vasculitides (LVV). As signs of vasculitis, US, MRI, and CT show a homogeneous arterial wall thickening, which is mostly concentric. PET displays increased FDG uptake in inflamed artery walls. US is recommended as the initial imaging modality in GCA. MRI and PET/CT may also detect vasculitis of temporal arteries. For TAK, MRI is recommended as the first imaging modality as it provides a good overview without radiation. Extracranial LVV can be confirmed by all four modalities. In addition, MRI and PET/CT provide consistent examination of the aorta and its branches. New techniques such as contrast-enhanced ultrasound, PET/MRI, and auxiliary methods such as “computer-assisted quantitative analysis” have emerged and need to be further validated. Summary Imaging has partly replaced histology for confirming LVV. Provided experience and adequate training, US, MRI, CT, or PET provide excellent diagnostic accuracy. Imaging results need to complement history and clinical examination. Ongoing studies are evaluating the role of imaging for monitoring and outcome measurement. Keywords Giant cell arteritis . Takayasu arteritis . Imaging . Diagnosis . Outcome . Large vessel vasculitis . Ultrasound . Magnetic resonance imaging . Computed tomography . 18F- fluorodeoxyglucose positron emission tomography
Introduction Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are granulomatous large vessel vasculitides (LVV). They are associated with considerable morbidity. Vision loss is common in GCA if initiation of treatment is delayed. Strokes and
Valentin Sebastian Schäfer and Lei Jin contributed equally to this work. This article is part of the Topical Collection on Recent Advances in Large Vessel Vasculitis * Valentin Sebastian Schäfer [email protected] 1
Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
2
Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
occlusions may occur in both GCA and TAK. Early diagnosis is crucial. Compared with histology, imaging is non-invasive, and results are readily available. Similar clinical, histopathologic, and imaging features suggest that they are somewhat related. Otherw
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