• The European League Against Rheumatism (EULAR) has developed 12 recommendations on how to use imaging for the diagnosis and monitoring of large vessel vasculitis.
• These evidence-based recommendations were arrived at by consensus among experts in the field of rheumatology.
Rationale for development of recommendations
Large vessel vasculitis is a very common form of primary vasculitis, which includes giant cell arteritis (GCA) and Takayasu arteritis (TAK). The increasing role of imaging modalities such as ultrasound necessitates updated recommendations to keep pace with technology and current research.
Christian Dejaco and colleagues across Europe point out, "These advances have brought along significant controversy and uncertainty about when to use which imaging technique, whether imaging might be helpful during follow-up to assess disease activity and damage, and whether imaging results might predict future outcomes."1
Recently, the authors presented the EULAR recommendations for the use of imaging modalities for the diagnosis, monitoring, and outcome prediction of primary large vessel vasculitis in Annals of the Rheumatic Diseases.
1. In patients with suspected GCA, an early imaging test is recommended to complement the clinical criteria for diagnosing GCA. Imaging should not delay initiation of treatment.
2. In patients in whom there is a high clinical suspicion of GCA and a positive imaging test, the diagnosis of GCA may be made without an additional test (biopsy or further imaging). In patients with a low clinical probability and a negative imaging result, the diagnosis of GCA can be considered unlikely.
3. Ultrasound of the temporal arteries with or without the axillary arteries is recommended as the first imaging modality in patients with suspected predominantly cranial GCA. A non-compressible "halo" sign is the ultrasound finding most suggestive of GCA.
4. High-resolution MRI of cranial arteries to investigate mural inflammation may be used as an alternative for GCA diagnosis if ultrasound is not available or inconclusive.
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1. Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis. Epub ahead of print: February 14, 2018. doi:10.1136/ annrheumdis-2017-212649