Imaging in systemic vasculitis

Abstract

Purpose of review: Imaging is becoming a relevant tool for the assessment of patients with systemic vasculitis. This review focuses on recently generated data with potential clinical impact in the diagnosis, evaluation of disease extent and management of systemic vasculitis.

Recent findings: Temporal artery examination by color duplex ultrasonography (CDUS) is a valuable approach to the diagnosis of giant-cell arteritis. Evaluation of additional arteries may increase its diagnostic performance. However, CDUS-specific findings may not be detected in arteries with early inflammation and CDUS-guidance of temporal artery biopsy does not seem to significantly increase its diagnostic yield. Large-vessel involvement detected by computed tomography angiography occurs in two out of three of patients with giant-cell arteritis at diagnosis. Furthermore, significant ascending aortic dilatation can be observed in one out of three of patients after long-term follow-up. Objective cut-offs for detecting large-vessel inflammation by positron emission tomography (PET) are trying to be established through prospective studies. PET may also contribute to the assessment of disease extent in patients with ANCA-associated vasculitis or Behçet's disease.

Summary: Data generated by existing and emerging imaging techniques are expected to have a major impact in the diagnosis, appraisal of disease extent, evaluation of disease activity and response to treatment in patients with systemic vasculitis.