Imaging in Vasculitis

Abstract

Purpose of review: Vasculitides are characterized by mostly autoimmunologically induced inflammatory processes of vascular structures. They have various clinical and radiologic appearances. Early diagnosis and reliable monitoring are indispensable for adequate therapy to prevent potentially serious complications. Imaging, in addition to laboratory tests and physical examination, constitutes a key component in assessing disease extent and activity. This review presents current standards and some typical findings in the context of imaging in vasculitis with particular attention to large vessel vasculitides.

Recent findings: Recently, imaging has gained importance in the management of vasculitis, especially regarding large vessel vasculitides (LVV). Recently, EULAR (European League Against Rheumatism) has launched its recommendations concerning the diagnosis of LVVs. Imaging is recommended as the preferred complement to clinical examination. Color-coded duplex sonography is considered the first choice imaging test in suspected giant cell arteritis, and magnetic resonance imaging is considered the first choice in suspected Takayasu's arteritis. Due to diversity of clinical and radiologic presentations, diagnosis and therapy monitoring of vasculitides may constitute a challenge. As a result of ongoing technological progress, a variety of non-invasive imaging modalities now play an elemental role in the interdisciplinary management of vasculitic diseases.

Keywords: EULAR guidelines; Giant cell arteritis (GCA); Imaging; Large vessel vasculitides (LVV); Magnetic resonance imaging (MRI); Vasculitis.

Fig. 1

Typical imaging findings in GCA: ultrasound under compression shows a non-compressible long-segmental hypoechoic “Halo” sign around both temporal arteries, representing inflammatory vessel wall edema (a, b, white arrows). T1-weighted contrast-enhanced MRI visualizes the correlating concentric vessel wall enhancement of the superficial temporal arteries and the extended inflammatory reaction of the surrounding tissue (c, d, white arrows)

Fig. 2

Characteristic findings in GCA with involvement of the aorta and first major branches: T1-weighted MRI shows smooth concentric vessel wall thickening and enhancement of the thoracic and abdominal aorta and the brachiocephalic trunk (a, b, white arrows). FDG-PET-CT reveals a correlating significant tracer uptake of the inflamed vessel walls along the thoracic aorta (d, white arrow) as well as along the supra-aortic branches including the bilateral axillary artery (c, arrows)

Fig. 3

Imaging findings in a patient with Takayasu’s arteritis: Contrast-enhanced MRA shows a long segmental occlusion of the right carotid artery with a filiform contrasting of the right internal carotid artery (a, white arrow)

Fig. 4

GCA patient with intracranial vasculitic involvement: T1-weighted MRI reveals long-segmental concentric wall thickening and enhancement of the right ICA in its extra- and intradural course (a–c, white arrows)