EULAR taps ultrasound as first-line diagnosis technique in giant cell arteritis
Click Here to Manage Email Alerts
Key takeaways:
- Imaging should be conducted by trained individuals with the appropriate equipment.
- Various imaging methods may be suitable depending on the disease and availability of equipment and staff.
Patients with suspected giant cell arteritis should undergo an ultrasound as the first-line imaging method, according to updated EULAR recommendations published in the Annals of the Rheumatic Diseases.
“Since 2018, new studies on imaging in [large vessel vasculitis (LVV)] have been published, some of them prompting a reconsideration of the original statements,” Christian Dejaco, MD, PhD, of the Medical University of Graz, in Austria, and colleagues wrote. “[Fluorodeoxyglucose positron emission tomography (FDG-PET)], for example, was previously considered inadequate for the assessment of temporal arteries because of the proximity to the brain. However, recent studies report that FDG-PET can detect temporal arteritis with high sensitivity and specificity.”
To investigate the changes in research and update the EULAR guidelines for the use of imaging in the management of large vessel vasculitis, Dejaco and colleagues formed a task force. Among the 24 members were rheumatologists, a radiologist, a nuclear medicine specialists, an internal medicine physician, epidemiologists, a methodologist, one patient representative, a rheumatology health professional, and two Emerging EULAR Network representatives.
Members conducted a systematic literature review focused on data from imaging studies, including papers if they featured more than 20 adult patients with relevant disease states. Following the literature review, the task force steering committee proposed updated guidance. The task force then voted on the updated guidelines. Points that achieved greater than 75% agreement on the first ballot were adopted. Guidelines were also added after achieving 66% on the second vote and 50% on the third.
In all, the updated guidelines include three overarching principles and eight recommendations. The overarching principles follow:
- Among patients with suspected GCA, early imaging tests are recommended to confirm diagnoses. In these cases, therapy should not be held on account of imaging.
- Imaging tests should only be conducted by trained professionals.
- Patients with a “high clinical suspicion” of GCA who have a positive imaging result can be diagnosed with GCA.
The recommendations follow:
- Temporal and axillary artery ultrasounds should be the first imaging technique used to check mural inflammatory changes in patients with suspected GCA.
- High-resolution MR-angiography (MRA) or FDG-PET can be used instead of ultrasound to assess cranial arteries in patients with possible GCA.
- In patients with potential GCA, FDG-PET, MRI or CT can be used to detect mural inflammation or luminal changes in extracranial arteries.
- In patients with potential Takayasu’s arteritis, MRI assessing mural inflammation or luminal changes should be the first imaging test used to make a diagnosis.
- FDG-PET, CT or ultrasound can be alternatives to MRI in patients with suspected Takayasu’s arteritis. However, the utility of ultrasound is limited in assessing the thoracic aorta.
- Patients with GCA or Takayasu’s arteritis are not recommended to undergo imaging with conventional angiography.
- In cases of a potential GCA or Takayasu’s arteritis relapse, ultrasound, FDG-PET or MRI are acceptable imaging methods for investigating vessel abnormalities.
- Patients with Takayasu’s arteritis or GCA may undergo MRA, CTA or ultrasound of the of extracranial vessels to monitor for long-term damage.
“Three overarching principles and eight recommendations are available to guide the use of imaging for the diagnosis and follow-up assessment of GCA and [Takayasu’s arteritis] in clinical practice,” Dejaco and colleagues wrote. “These recommendations are based on evidence and expert consensus.”
Collapse
Read more about
Click Here to Manage Email Alerts