NEW YORK (Reuters Health)—Patients with suspected large-vessel vasculitis (LVV) should undergo early imaging, the European League Against Rheumatism (EULAR) advises in a new report presenting a dozen evidence-based recommendations for the use of imaging in primary LVV.
Ultrasound should be the first choice for giant-cell arteritis (GCA), while MRI should take precedence for Takayasu arteritis (TAK), Dr. Christian Dejaco from Medical University Graz, Austria, and colleagues from 10 EULAR countries note in Annals of the Rheumatic Diseases, online Jan. 22.1
Alternative choices include MRI for GCA and CT or PET for TAK, according to the authors, who reviewed the literature to arrive at their recommendations.
Conventional angiography is no longer advised for the diagnosis of GCA or TAK, as it has been superseded by the currently recommended imaging modalities.
Although imaging is not routinely recommended for patients in clinical and biochemical remission, it may be used in patients with suspected flares or for long-term monitoring of structural damage.
The recommendations stress the importance of having imaging examinations done by a trained specialist using appropriate equipment, operational procedures and settings. They also provide suggestions for technical and operational parameters.
Due to the absence of evidence and experience, no recommendations on the prognostic value of imaging modalities in patients with established GCA and TAK currently exist.
To address this and other shortages of evidence, the group suggests a future research agenda of 19 possible investigative endeavors, ranging from defining diagnostic gold standards to determining whether therapy should be modified based on imaging results alone.
“We expect that much progress (will) continue to take place in the area of imaging in LVV, and we will carefully follow developments in the field, assuming that an amendment of these recommendations may be needed within a few years,” the authors conclude.
Dr. Dejaco did not respond to a request for comment.
- 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. 2018 Jan 22. pii: annrheumdis-2017-212649. doi: 10.1136/annrheumdis-2017-212649. [Epub ahead of print]