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Meta-Analysis
. 2023 Aug;9(3):e003379.
doi: 10.1136/rmdopen-2023-003379.

Imaging in diagnosis, monitoring and outcome prediction of large vessel vasculitis: a systematic literature review and meta-analysis informing the 2023 update of the EULAR recommendations

Philipp Bosch #  1 , Milena Bond #  2 , Christian Dejaco  1   2 , Cristina Ponte  3   4 , Sarah Louise Mackie  5   6 , Louise Falzon  7 , Wolfgang A Schmidt  8 , Sofia Ramiro  9   10
Affiliations
Meta-Analysis

Imaging in diagnosis, monitoring and outcome prediction of large vessel vasculitis: a systematic literature review and meta-analysis informing the 2023 update of the EULAR recommendations

Philipp Bosch et al. RMD Open. 2023 Aug.

Abstract

Objectives: To update the evidence on imaging for diagnosis, monitoring and outcome prediction in large vessel vasculitis (LVV) to inform the 2023 update of the European Alliance of Associations for Rheumatology recommendations on imaging in LVV.

Methods: Systematic literature review (SLR) (2017-2022) including prospective cohort and cross-sectional studies (>20 participants) on diagnostic, monitoring, outcome prediction and technical aspects of LVV imaging. Diagnostic accuracy data were meta-analysed in combination with data from an earlier (2017) SLR.

Results: The update retrieved 38 studies, giving a total of 81 studies when combined with the 2017 SLR. For giant cell arteritis (GCA), and taking clinical diagnosis as a reference standard, low risk of bias (RoB) studies yielded pooled sensitivities and specificities (95% CI) of 88% (82% to 92%) and 96% (95% CI 86% to 99%) for ultrasound (n=8 studies), 81% (95% CI 71% to 89%) and 98% (95% CI 89% to 100%) for MRI (n=3) and 76% (95% CI 67% to 83%) and 95% (95% CI 71% to 99%) for fluorodeoxyglucose positron emission tomography (FDG-PET, n=4), respectively. Compared with studies assessing cranial arteries only, low RoB studies with ultrasound assessing both cranial and extracranial arteries revealed a higher sensitivity (93% (95% CI 88% to 96%) vs 80% (95% CI 71% to 87%)) with comparable specificity (94% (95% CI 83% to 98%) vs 97% (95% CI 71% to 100%)). No new studies on diagnostic imaging for Takayasu arteritis (TAK) were found. Some monitoring studies in GCA or TAK reported associations of imaging with clinical signs of inflammation. No evidence was found to determine whether imaging severity might predict worse clinical outcomes.

Conclusion: Ultrasound, MRI and FDG-PET revealed a good performance for the diagnosis of GCA. Cranial and extracranial vascular ultrasound had a higher pooled sensitivity with similar specificity compared with limited cranial ultrasound.

Keywords: Magnetic Resonance Imaging; giant cell arteritis; systemic vasculitis; ultrasonography.

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Conflict of interest statement

Competing interests: PB has received speaker fees by Janssen and project grants by Pfizer. MB has received research grants from AbbVie. CD has received consulting/speaker’s fees from Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, all unrelated to this manuscript. He is an editorial board member of ARD. WAS has received speaker honoraria from Abbvie, Amgen, Bristol Myers Squibb, Chugai, Lilly, Johnson & Johnson, Medac, Novartis, Pfizer, Roche, Sanofi, and UCB; consultancy fees from Abbvie, Amgen, Bristol Myers Squibb, Chugai, GlaxoSmithKline, Novartis, Roche, and Sanofi. He is principal investigator of phase 2 and phase 3 trials sponsored by Abbvie, GlaxoSmithKline, Novartis, and Sanofi. CP is or has been the principal investigator of studies by AbbVie, Sanofi and Novartis and has received consulting/speaker’s fees from CSL Vifor, AbbVie, AstraZeneca, GlaxoSmithKline and Roche, all unrelated to this manuscript. SLM reports: Consultancy on behalf of her institution for Roche/Chugai, Sanofi, AbbVie, AstraZeneca, Pfizer; Investigator on clinical trials for Sanofi, GSK, Sparrow; speaking/lecturing on behalf of her institution for Roche/Chugai, Vifor, Pfizer, UCB, Novartis and AbbVie; chief investigator on STERLING-PMR trial, funded by NIHR; patron of the charity PMRGCAuk. No personal remuneration was received for any of the above activities. Support from Roche/Chugai to attend EULAR2019 in person and from Pfizer to attend ACR Convergence 2021 virtually. SLM is supported in part by the NIHR Leeds Biomedical Research Centre. The views expressed in this article are those of the authors and not necessarily those of the NIHR, the NIHR Leeds Biomedical Research Centre, the National Health Service or the UK Department of Health and Social Care. SR has received research grants and/or consultancy fees from AbbVie, Eli Lilly, Galapagos, MSD, Novartis, Pfizer, UCB.

Figures

Figure 1
Figure 1
Diagnostic performance of ultrasound, MRI and FDG-PET in comparison with clinical diagnosis as reference standard for the diagnosis of GCA according to low RoB studies Diagnostic performance according to all studies is depicted in online supplemental figure S3–S5. This plot only contains studies with low risk of bias. FN, false negative; FP, false positive; FDG-PET, fluorodeoxyglucose positron emission tomography; GCA, giant cell arteritis; N, number of participants; RoB, Risk of bias; TN, true negative; TP, true positive.
See this image and copyright information in PMC

References

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