EULAR: MRI, PET can be used ‘as an alternative’ to ultrasound for cranial arteries in GCA
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MRI and PET scans are viable alternatives to ultrasound for cranial arteries in patients with suspected giant cell arteritis, according to a 2023 update of EULAR’s recommendations for imaging in large vessel vasculitis.
“We wanted to develop recommendations for the use of imaging in several aspects of large vessel vasculitis diagnosis, monitoring and outcome prediction,” Christian Dejaco, MD, PhD, a member of the EULAR standing committee on musculoskeletal imaging, told attendees.
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Dejaco, who is also a consultant and associate professor in the department of rheumatology at the Medical University of Graz, in Austria, noted that the two patient populations targeted in the document are those with giant cell arteritis and Takayasu arteritis.
The guideline development process followed protocols for other EULAR recommendations, including a literature review, PICO questions, task force meetings and voting rounds.
“The level of evidence was heterogeneous,” Dejaco said. “But the level of agreement was very, very high for each statement.”
The 2023 document now includes three overarching principles and eight recommendations. Regarding the overarching principles, Dejaco noted that imaging should be used early in the patient assessment process.
“Once we have started treatment with steroids, as early as day 3 onwards, the sensitivity of any individual imaging test is going to decline,” he said.
The second principle was condensed and deals mainly with the standardization of imaging analyses, while the third principle remains largely unchanged from the 2018 recommendations.
Moving to the actual recommendations, Dejaco noted the ultrasound remains the first-line option for diagnostic imaging.
“The major change that we have made here is that we suggest ultrasound of temporal and axillary arteries in all patients with suspected GCA,” he said.
The second recommendation contains the “most intriguing changes,” according to Dejaco.
“For the cranial arteries, as an alternative to ultrasound, you can use MRI or PET,” he said.
In the third statement, a note on ultrasound was removed because it was covered in the first recommendation, according to Dejaco.
The fourth and fifth statements provide guidance on imaging in Takayasu arteritis.
“They were essentially unchanged because there was no single paper with new evidence on that,” Dejaco said. “Use MRI in the first place. Ultrasound, PET or CT may also be used for diagnostic purposes.”
The last two recommendations deal with monitoring GCA and Takayasu arteritis.
“The evidence that we had was heterogeneous,” Dejaco said.
Of note, if there is doubt about the efficacy of the medications or if the patient is not experiencing optimal benefit, imaging may be used to monitor the patient.
“However, when patients are in clinical and laboratory remission, we do not routinely recommend imaging to prove that state of remission,” Dejaco said.
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Dejaco C. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update. Presented at: EULAR 2023 Congress; May 31 to June 3, 2023, Milan, Italy.
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