Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and meta-analysis informing the EULAR recommendations

Abstract

ObjectivesTo perform a systematic literature review on imaging techniques for diagnosis, outcome prediction and disease monitoring in large vessel vasculitis (LVV) informing the European League Against Rheumatism recommendations for imaging in LVV.MethodsSystematic literature review (until 10 March 2017) of diagnostic and prognostic studies enrolling >20 patients and investigating ultrasound, MRI, CT or positron emission tomography (PET) in patients with suspected and/or established primary LVV. Meta-analyses were conducted, whenever possible, obtaining pooled estimates for sensitivity and specificity by fitting random effects models.ResultsForty-three studies were included (39 on giant cell arteritis (GCA), 4 on Takayasu arteritis (TAK)). Ultrasound (‘halo’ sign) at temporal arteries (8 studies, 605 patients) and MRI of cranial arteries (6 studies, 509 patients) yielded pooled sensitivities of 77% (95% CI 62% to 87%) and 73% (95% CI 57% to 85%), respectively, compared with a clinical diagnosis of GCA. Corresponding specificities were 96% (95% CI 85% to 99%) and 88% (95% CI 81% to 92%). Two studies (93 patients) investigating PET for GCA diagnosis reported sensitivities of 67%–77% and specificities of 66%–100% as compared with clinical diagnosis or temporal artery biopsy. In TAK, one study each evaluated the role of magnetic resonance angiography and CT angiography for diagnostic purposes revealing both a sensitivity and specificity of 100%. Studies on outcome prediction and monitoring disease activity/damage were limited and mainly descriptive.ConclusionsUltrasound and MRI provide a high diagnostic value for cranial GCA. More data on the role of imaging for diagnosis of extracranial large vessel GCA and TAK, as well as for outcome prediction and monitoring in LVV are warranted.

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

“…The ‘halo’ sign at temporal arteries revealed a pooled sensitivity of 77% and a pooled specificity of 96% as compared with the clinical diagnosis of GCA 12. These values remained consistent in a series of sensitivity analyses 12. The persistence of a hypoechoic swelling despite the compression of the artery lumen with the ultrasound probe (termed ‘compression’ sign) is a variant of the ‘halo’ sign revealing sensitivities of 77%–79% and a specificity of 100% 27 28.…”

“…For example, a patient with 50 years of age, with chronic unspecific headache and normal inflammatory markers has a very low pretest clinical probability for the presence of GCA. Assuming a pretest probability of 5% and a positive ultrasound result (which has a 77% sensitivity and a 96% specificity),12 the post-test probability would increase to 50% only 24. In case of a negative test, however, the diagnosis of GCA is very unlikely with a post-test probability of 1.3%.…”

“…Recently, it has been defined by an Outcome Measures in Rheumatology  (OMERACT) working group as a ‘homogenous, hypoechoic wall thickening that is well delineated towards the luminal side that is visible both in longitudinal and transverse planes, most commonly concentric in transverse scans’ 26. The ‘halo’ sign at temporal arteries revealed a pooled sensitivity of 77% and a pooled specificity of 96% as compared with the clinical diagnosis of GCA 12. These values remained consistent in a series of sensitivity analyses 12.…”

“…The evidence summarised in the SLR was presented to the task force in the form of tables summarising the findings, including an assessment of the risk of bias of the studies 10 11. The SLR is published separately12; however, the SLR and the present recommendations manuscript form an integral and inseparable part and should be read as such.…”

Systemic Vasculitis With Lesion of Large Vessels as a Cause of Art Erial Hypert Ension in a Patient of Young Age

“…Значительное утол-щение стенки внутри и вокруг аорты наблюдается в острой фазе АТ. Также утолщение стенок сосудов от-мечается и в хронической стадии, что указывает на возможность определения активности заболевания на тканевом уровне [17,18]. Ангиография при АТ при-меняется в настоящее время преимущественно для предоперационной оценки сосудистого русла при не-обходимости реконструктивных операций на сосудах.…”