Imaging in Vasculitis

Abstract

Purpose of Review Vasculitides are characterized by mostly autoimmunologically induced inflammatory processes of vascular structures. They have various clinical and radiologic appearances. Early diagnosis and reliable monitoring are indispensable for adequate therapy to prevent potentially serious complications. Imaging, in addition to laboratory tests and physical examination, constitutes a key component in assessing disease extent and activity. This review presents current standards and some typical findings in the context of imaging in vasculitis with particular attention to large vessel vasculitides. Recent Findings Recently, imaging has gained importance in the management of vasculitis, especially regarding large vessel vasculitides (LVV). Recently, EULAR (European League Against Rheumatism) has launched its recommendations concerning the diagnosis of LVVs. Imaging is recommended as the preferred complement to clinical examination. Color-coded duplex sonography is considered the first choice imaging test in suspected giant cell arteritis, and magnetic resonance imaging is considered the first choice in suspected Takayasu's arteritis. Summary Due to diversity of clinical and radiologic presentations, diagnosis and therapy monitoring of vasculitides may constitute a challenge. As a result of ongoing technological progress, a variety of non-invasive imaging modalities now play an elemental role in the interdisciplinary management of vasculitic diseases. Keywords Vasculitis . Large vessel vasculitides (LVV) . Giant cell arteritis (GCA) . Imaging . Magnetic resonance imaging (MRI) . EULAR guidelinesThis article is part of the Topical Collection on Imaging

A Case of Giant Cell Arteritis Presenting As Catastrophic Posterior Circulation Stroke: A Diagnostic Dilemma

“…A non-invasive duplex ultrasound scan is the first-line imaging modality for suspected GCA, given its availability and lack of radiation exposure. The presence of a hypoechoic wall thickening - “halo sign” around both temporal arteries represents inflammatory vessel wall edema and is suggestive of temporal artery inflammation [ 7 ]. The sensitivity and specificity of ultrasound diagnosis of GCA were reported to be 91.6% and 95.8%, respectively, when compared with the histological diagnosis in a study of 451 consecutive patients with GCA [ 8 ].…”

Migrant cavitation as primary involvement in a particular case of granulomatosis with polyangiitis

“… [14] the most common pattern in CT is the presence of multiple nodules, including some cavitates and migrants. According to Guggenberger et al., while pulmonary nodules are primarily asymptomatic, may evolve into pulmonary hemorrhages and, in some cases, cause a more severe, potentially fatal, lung-kidney syndrome [1] . Therapy is based on immunosuppressants (cyclophosphamide, methotrexate, and steroids).…”

“…Vasculitis is a heterogeneous group of disorders characterized by inflammation and necrosis of the blood vessel wall. The clinical and radiological manifestations are very variable and depend on the anatomical localization, the size of the vessels involved and the inflammation's characteristics [1] . The Chapel Hill Consensus Conference classified them according to the caliber of the affected vessels, distinguishing in vasculitis of large vessels, vasculitis of medium vessels, and vasculitis of small vessels [2] .…”

Pediatric cardiothoracic vasculitis: multimodality imaging review

“…Ultrasound (US), including echocardiography, can be a helpful cardiovascular screening test but can underestimate or incompletely characterize the full extent of disease. Conventional angiography is preferably reserved for concurrent intervention [ 10 , 11 ]. In general, the purpose of imaging in medium- to large-vessel vasculitis is to evaluate the vessels, while the goal in small- to medium-vessel vasculitis is to assess for end-organ disease complications.…”

“…CT is generally more optimal for assessing the lungs, airways and coronaries as well as any calcifications (e.g., from chronic inflammation) or metallic material (e.g., post-surgical stents). MRI offers improved tissue (e.g., vessel wall) characterization and nearly comparable spatial resolution without ionizing radiation and potentially without contrast agent [ 1 , 2 , 10 , 11 ]. Nevertheless, these traditional distinctions have become increasingly blurred with ongoing advances both in CT (e.g., dual-energy/spectral CT for improved tissue contrast; CT-derived fractional flow reserve for coronary stenosis hemodynamic interrogation) and MRI (e.g., ultrashort echo time [UTE] and zero echo time [ZTE] techniques with conical or radial k-space sampling for lung and airway assessment; four-dimensional [4-D] blood-flow interrogation) [ 12 – 16 ].…”