A pragmatic approach to imaging in large vessel vasculitis

Abstract

Introduction: As the presentation of large vessel vasculitis (LVV) is manifold, diagnosing it before development of complications remains challenging. It is vital to reach an early diagnosis in order to prevent stenosis, aneurysms or occlusions. Imaging techniques can be helpful and in recent years the role of temporal artery ultrasound and the combination of positron emission tomography with computed tomography (PET-CT) have been highlighted.

Areas covered: This article describes indications for imaging in LVV and discusses usefulness of available imaging modalities.

Expert opinion: Ultrasonography and PET-CT play a very important role in the early diagnosis of LVV. Wherever possible, patients should receive the lowest possible immunosuppressive and GC therapy (< prednisolone 7.5 mg daily or equivalent) a week prior to the PET-CT. Because of its expense and significant radiation exposure, PET-CT is best selected for patients where other available investigations have been non-contributory. Vascular sonography can also be used during follow-up. There is an urgent need for classification of LVV based on imaging.

Keywords:

• giant cell arteritis
• imaging
• positron emission tomography with computed tomography
• ultrasonography
• vasculitis

Declaration of interest

B Dasgupta has participated in clinical trials and board membership for Roche, Napp Pharmaceuticals, GlaxoSmithKline, Mundipharma and Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Notes

This box summarizes key points contained in the article.