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

Christian Dejaco*, Sofia Ramiro, Christina Duftner, Florent L Besson, Thorsten A Bley, Daniel Blockmans, Elisabeth Brouwer, Marco A Cimmino, Eric Clark, Bhaskar Dasgupta, Andreas P Diamantopoulos, Haner Direskeneli, Annamaria Iagnocco, Thorsten Klink, Lorna Neill, Cristina Ponte, Carlo Salvarani, Riemer H J A Slart, Madeline Whitlock, Wolfgang A Schmidt

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

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Abstract

To develop evidence-based recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV) including giant cell arteritis (GCA) and Takayasu arteritis (TAK). European League Against Rheumatism (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound, MRI, CT and [F-18]-fluorodeoxyglucose positron emission tomography (PET) in LVV. Based on evidence and expert opinion, the task force consisting of 20 physicians, healthcare professionals and patients from 10 EULAR countries developed recommendations, with consensus obtained through voting. The final level of agreement was voted anonymously. A total of 12 recommendations have been formulated. The task force recommends an early imaging test in patients with suspected LVV, with ultrasound and MRI being the first choices in GCA and TAK, respectively. CT or PET may be used alternatively. In case the diagnosis is still in question after clinical examination and imaging, additional investigations including temporal artery biopsy and/or additional imaging are required. In patients with a suspected flare, imaging might help to better assess disease activity. The frequency and choice of imaging modalities for long-term monitoring of structural damage remains an individual decision; close monitoring for aortic aneurysms should be conducted in patients at risk for this complication. All imaging should be performed by a trained specialist using appropriate operational procedures and settings. These are the first EULAR recommendations providing up-to-date guidance for the role of imaging in the diagnosis and monitoring of patients with (suspected) LVV.

Original languageEnglish
Pages (from-to)636-643
Number of pages8
JournalAnnals of the Rheumatic Diseases
Volume77
Issue number5
DOIs
Publication statusPublished - May-2018

Keywords

  • GIANT-CELL ARTERITIS
  • COLOR-DUPLEX ULTRASONOGRAPHY
  • POSITRON-EMISSION-TOMOGRAPHY
  • TERM-FOLLOW-UP
  • TEMPORAL ARTERITIS
  • POLYMYALGIA-RHEUMATICA
  • DOPPLER ULTRASONOGRAPHY
  • TAKAYASUS-ARTERITIS
  • DIAGNOSIS
  • SONOGRAPHY

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