The Role of Vascular Imaging to Advance Clinical Care and Research in Large-Vessel Vasculitis

Abstract

Purpose of the Review: The two main forms of large-vessel vasculitis (LVV) are giant cell arteritis (GCA) and Takayasu's arteritis (TAK). Vascular imaging can characterize disease activity and disease extent in LVV. This review critically analyzes the clinical utility of vascular imaging in LVV and highlights how imaging may be incorporated into the management and study of these conditions.Recent Findings: There are multiple imaging modalities available to assess LVV including ultrasonography, CT angiography (CTA), magnetic resonance angiography (MRA), and 18 Ffluorodeoxyglucose (FDG) positron emission tomography (PET). As these techniques are refined, imaging may be increasingly useful to evaluate the cranial arteries and the aorta and its primary branches. In addition, vascular imaging may be useful to monitor disease activity and may have prognostic value to predict future clinical events.Summary: There are strengths and weaknesses associated with vascular imaging that should be considered when evaluating patients with LVV. Vascular imaging will likely play an increasingly important role in the clinical management of patients and the conduct of research in LVV and may ultimately be incorporated as outcome measures in clinical trials in these conditions.

Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

“…High-resolution MRI has been shown to be useful for the diagnosis and long-term monitoring of GCA [7,8,16]. Vasculitis on MRI findings presents as increased vessel wall thickness and edema with increased mural enhancement on high-resolution post-contrast images.…”

“…PET/CT yields an exceptional overview of the extension of vascular inflammation. In addition, it is useful to rule out other entities such as malignancy or infection (Figure 2) [7,8,14,49].…”

“…PET/CT yields an exceptional overview of the extension of vascular inflammation. In addition, it is useful to rule out other entities such as malignancy or infection (Figure 2) [7,8,14,49]. The acquisition and interpretation of FDG-PET/CT images for LVV diagnosis can be challenging.…”

“…These criteria have been of great help in the identification of patients with the classic cranial symptoms of GCA and, therefore, temporal artery biopsy has been considered, for many years, as the gold standard in confirming the diagnosis of GCA [3]. However, ultrasound (US) of the temporal arteries has emerged as an alternative method to detect inflammatory changes in the vessel wall without the need for biopsy [7][8][9]. In this sense, this imaging technique has progressively gained the support of physicians for use in the early diagnosis of GCA.…”

Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM

“…When PET/CTA is performed to diagnose device infection, a prospective, ECG-gated, venous phase CTA sequence is recommended to evaluate local soft tissue changes, lead vegetation, and venous thrombosis of the vascular accesses. In case of vasculitis, CTA is helpful to evaluate the arterial wall thickness for primary diagnosis, and to monitor vascular stenosis during disease progression ( 16 , 54 ) (Table 2 ). CTA is clinically applied for the evaluation of plaque composition and characterization of high risk plaques, the degree of luminal stenosis and vascular calcifications using nonenhanced CT in atherosclerotic disease, with coronary CTA widely used in the assessment of patients presenting with chest pain ( 55 – 57 ) (Table 2 ).…”