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EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice
  1. Christian Dejaco1,2,
  2. Sofia Ramiro3,
  3. Christina Duftner4,
  4. Florent L Besson5,6,
  5. Thorsten A Bley7,
  6. Daniel Blockmans8,
  7. Elisabeth Brouwer9,
  8. Marco A Cimmino10,
  9. Eric Clark11,
  10. Bhaskar Dasgupta12,13,
  11. Andreas P Diamantopoulos14,
  12. Haner Direskeneli15,
  13. Annamaria Iagnocco16,
  14. Thorsten Klink7,
  15. Lorna Neill17,
  16. Cristina Ponte18,19,
  17. Carlo Salvarani20,21,
  18. Riemer H J A Slart22,23,
  19. Madeline Whitlock12,
  20. Wolfgang A Schmidt24
  1. 1 Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria
  2. 2 Department of Rheumatology, South Tyrol Health Trust, Hospital of Bruneck, Bruneck, Italy
  3. 3 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4 Department of Internal Medicine VI, Medical University Innsbruck, Innsbruck, Austria
  5. 5 Department of Biophysics and Nuclear Medicine, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicetre, Île-de-France, France
  6. 6 IR4M-UMR8081, Université Paris-Saclay, Orsay, France
  7. 7 Department of Diagnostic and Interventional Radiology, University Medical Center Wuerzburg, Wuerzburg, Germany
  8. 8 General Internal Medicine Department, University Hospital Gasthuisberg, Leuven, Belgium
  9. 9 Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groiningen, The Netherlands
  10. 10 Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
  11. 11 Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
  12. 12 Department of Rheumatology, Southend Hospital NHS Trust, Westcliff-on-Sea, UK
  13. 13 Anglia Ruskin University, Chelmsford, UK
  14. 14 Department of Rheumatology, Martina Hansens Hospital, Baerum, Norway
  15. 15 Division of Rheumatology, Department of Internal Medicine, Marmara University, Istanbul, Turkey
  16. 16 Rheumatology Unit, Universita degli Studi di Torino Dipartimento di Scienze Mediche, Torino, Italy
  17. 17 Polymyalgia Rheumatica and Giant Cell Arteritis Scotland (PMR-GCA Scotland), Perth, UK
  18. 18 Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
  19. 19 Rheumatology Department, Hospital de Santa Maria – Centro Hospitalar Lisboa Norte, Lisbon, Portugal
  20. 20 Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
  21. 21 Dipartimento di Scienze della Vita, Universita degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
  22. 22 Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  23. 23 Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
  24. 24 Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
  1. Correspondence to Dr Christian Dejaco, Department of Rheumatology and Immunology, Medical University Graz, Graz 8036, Austria; christian.dejaco{at}gmx.net

Abstract

To develop evidence-based recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV) including giant cell arteritis (GCA) and Takayasu arteritis (TAK). European League Against Rheumatism (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound, MRI, CT and [18F]-fluorodeoxyglucose positron emission tomography (PET) in LVV. Based on evidence and expert opinion, the task force consisting of 20 physicians, healthcare professionals and patients from 10 EULAR countries developed recommendations, with consensus obtained through voting. The final level of agreement was voted anonymously. A total of 12 recommendations have been formulated. The task force recommends an early imaging test in patients with suspected LVV, with ultrasound and MRI being the first choices in GCA and TAK, respectively. CT or PET may be used alternatively. In case the diagnosis is still in question after clinical examination and imaging, additional investigations including temporal artery biopsy and/or additional imaging are required. In patients with a suspected flare, imaging might help to better assess disease activity. The frequency and choice of imaging modalities for long-term monitoring of structural damage remains an individual decision; close monitoring for aortic aneurysms should be conducted in patients at risk for this complication. All imaging should be performed by a trained specialist using appropriate operational procedures and settings. These are the first EULAR recommendations providing up-to-date guidance for the role of imaging in the diagnosis and monitoring of patients with (suspected) LVV.

  • giant cell arteritis
  • ultrasonography
  • magnetic resonance imaging
  • systemic vasculitis

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Footnotes

  • Handling editor Josef S Smolen

  • Contributors All authors were involved in the discussion and formulation of the recommendations. ChristiaD wrote the first version of the manuscript. All authors reviewed it and made extensive comments and appropriate changes to it. All authors approved the final version of the manuscript.

  • Funding Funding was provided by the European League Against Rheumatism.

  • Competing interests TAB received research grants from Deutsche Forschungsgemeinschaft (DFG) and Siemens Healthineers and received consultancies and speaker fees from HeartFlow, GSK, MSD, Roche, Bayer, Bracco, Guerbet and Siemens. EB received consultancies and speaker fees from Roche, which were paid to the University Medical Center Groningen. BD has received consultancies from Roche, GSK and Munidipharma. APD received speaker fees from Roche. WS received consultancies and speakers fee from Roche and GSK. All other authors have no competing interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Correction notice This article has been corrected since it published Online First. The text in box 1 has been corrected.

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