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EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice

Published on May 1, 2018in Annals of the Rheumatic Diseases14.299
· DOI :10.1136/annrheumdis-2017-212649
Christian Dejaco27
Estimated H-index: 27
,
Sofia Ramiro27
Estimated H-index: 27
(LUMC: Leiden University Medical Center)
+ 17 AuthorsWolfgang A. Schmidt32
Estimated H-index: 32
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.
  • References (55)
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References55
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#2Christina Duftner (Innsbruck Medical University)H-Index: 24
Last. Wolfgang A. SchmidtH-Index: 32
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Objectives To define the elementary ultrasound (US) lesions in giant cell arteritis (GCA) and to evaluate the reliability of the assessment of US lesions according to these definitions in a web-based reliability exercise. Methods Potential definitions of normal and abnormal US findings of temporal and extracranial large arteries were retrieved by a systematic literature review. As a subsequent step, a structured Delphi exercise was conducted involving an expert panel of the Outcome Measures in R...
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#1Sara Monti (UNIPV: University of Pavia)H-Index: 9
#2Alberto FlorisH-Index: 8
Last. Raashid Luqmani (NOC: Nuffield Orthopaedic Centre)H-Index: 53
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#1Aytac Gulcu (Dokuz Eylül University)H-Index: 12
#2Naciye Sinem Gezer (Dokuz Eylül University)H-Index: 6
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Background This retrospective study evaluated the long-term results of endovascular repair in the management of arterial stenosis caused by Takayasu's arteritis (TA). Methods Sixty-seven endovascular procedures (percutaneous transluminal balloon angioplasty or stenting) were performed for 49 arterial lesions in 35 patients. Endovascular treatment was performed when the disease was inactive. The patients were pretreated with immunosuppressive drugs and were followed every 3–6 months to monitor di...
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Abstract Takayasu's arteritis (TAK) is a rare, chronic, large-vessel vasculitis (LVV) that predominantly affects aorta, its major branches and the pulmonary arteries. Recent controversial issues in the diagnosis, disease assessment and prognosis in TAK are discussed in this review. In recent years, conventional angiography, the standard method for the initial diagnosis, seems to have been replaced by the new imaging modalities, such as MRI and 18F-FDG-PET. Less invasive techniques (CT/MRI) are n...
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#1Raashid Luqmani (University of Oxford)H-Index: 53
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Giant cell arteritis (GCA) may affect the brain-supplying arteries, resulting in ischemic stroke, whereby the vertebrobasilar territory is most often involved. Since etiology is unknown in 25% of stroke patients and GCA is hardly considered as a cause, we examined in a pilot study, whether screening for GCA after vertebrobasilar stroke might unmask an otherwise missed disease. Consecutive patients with vertebrobasilar stroke were prospectively screened for GCA using erythrocyte sedimentation rat...
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