Imaging for large-vessel vasculitis.
OBJECTIVE
Ultrasonography, MRI, and PET are increasingly studied in large-vessel vasculitis. They have broadened our knowledge on these disorders and have a place in the diagnostic approach of these patients.


RESULTS
Temporal artery ultrasonography can be used to guide the surgeon to that artery segment with the clearest 'halo' sign to perform a biopsy, or in experienced hands can even replace biopsy. The distal subclavian, axillary, and brachial arteries can also be examined. High-resolution MRI depicts superficial cranial and extracranial involvement patterns in giant cell arteritis (GCA). Contrast enhancement is prominent in active inflammation and decreases under successful steroid therapy. Presence of aortic complications such as aneurysm or dissection can be ruled out within the same investigation. Large thoracic vessel FDG-uptake is seen in the majority of patients with GCA, especially at the subclavian arteries and the aorta. FDG-PET cannot predict which patients are bound to relapse, and once steroids are started, interpretation is hazardous, which makes its role in follow-up uncertain. Increased thoracic aortic FDG-uptake at diagnosis of GCA may be a bad prognostic factor for later aortic dilatation. In patients with isolated polymyalgia rheumatica - who have less intense vascular FDG uptake - symptoms are caused by inflammation around the shoulders, hips, and spine.


CONCLUSIONS
Ultrasonography, MRI, and PET remain promising techniques in the scientific and clinical approach of large-vessel vasculitis.
Blockmans
Daniel
D
General Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium. Daniel.Blockmans@uz.kuleuven.ac.be
Bley
Thorsten
T
Schmidt
Wolfgang
W
D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology; D001158:Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D019788:Fluorodeoxyglucose F18; D013700:Giant Cell Arteritis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000639:trends; D049268:Positron-Emission Tomography / Q000379:methods* / Q000639:trends; D011237:Predictive Value of Tests; D014463:Ultrasonography / Q000379:methods* / Q000639:trends; D014657:Vasculitis / Q000000981:diagnostic imaging* / Q000473:pathology
D019788:Fluorodeoxyglucose F18