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. 2018 Feb 2;4(1):e000612.
doi: 10.1136/rmdopen-2017-000612. eCollection 2018.

Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and meta-analysis informing the EULAR recommendations

Christina Duftner  1 , Christian Dejaco  2   3 , Alexandre Sepriano  4   5 , Louise Falzon  6 , Wolfgang Andreas Schmidt  7 , Sofia Ramiro  4
Affiliations

Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and meta-analysis informing the EULAR recommendations

Christina Duftner et al. RMD Open. .

Abstract

Objectives: To perform a systematic literature review on imaging techniques for diagnosis, outcome prediction and disease monitoring in large vessel vasculitis (LVV) informing the European League Against Rheumatism recommendations for imaging in LVV.

Methods: Systematic literature review (until 10 March 2017) of diagnostic and prognostic studies enrolling >20 patients and investigating ultrasound, MRI, CT or positron emission tomography (PET) in patients with suspected and/or established primary LVV. Meta-analyses were conducted, whenever possible, obtaining pooled estimates for sensitivity and specificity by fitting random effects models.

Results: Forty-three studies were included (39 on giant cell arteritis (GCA), 4 on Takayasu arteritis (TAK)). Ultrasound ('halo' sign) at temporal arteries (8 studies, 605 patients) and MRI of cranial arteries (6 studies, 509 patients) yielded pooled sensitivities of 77% (95% CI 62% to 87%) and 73% (95% CI 57% to 85%), respectively, compared with a clinical diagnosis of GCA. Corresponding specificities were 96% (95% CI 85% to 99%) and 88% (95% CI 81% to 92%). Two studies (93 patients) investigating PET for GCA diagnosis reported sensitivities of 67%-77% and specificities of 66%-100% as compared with clinical diagnosis or temporal artery biopsy. In TAK, one study each evaluated the role of magnetic resonance angiography and CT angiography for diagnostic purposes revealing both a sensitivity and specificity of 100%. Studies on outcome prediction and monitoring disease activity/damage were limited and mainly descriptive.

Conclusions: Ultrasound and MRI provide a high diagnostic value for cranial GCA. More data on the role of imaging for diagnosis of extracranial large vessel GCA and TAK, as well as for outcome prediction and monitoring in LVV are warranted.

Keywords: giant cell arteritis; magnetic resonance imaging; ultrasonography.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Diagnostic performance of different ultrasound (US) signs of vasculitis and MRI studies in comparison with clinical diagnosis as reference standard. (B) Diagnostic performance of different US signs of vasculitis and MRI studies in comparison with temporal artery biopsy as reference standard. TP, true positives; FP, false positives; FN, false negatives; TN, true negatives.
See this image and copyright information in PMC

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