Ultrasound imaging in the diagnosis of large vessel vasculitis

Abstract

Summary: Nowadays noninvasive vascular imaging has an important role in the diagnostic work-up of the large vessel vasculitides (LVV), most importantly giant cell arteritis (GCA) and Takayasu arteritis. Among the imaging modalities available, ultrasound (US) has several important advantages, including low costs, rapid and repetitive availability without exposure to radiation, and high spatial resolution for assessment of large and medium-sized arteries. Therefore, US can be regarded the fi rst line imaging method in suspected LVV. In patients with suspected GCA, US can replace temporal artery biopsy in certain clinical scenarios, and the application of US early in the diagnostic work-up of suspected GCA in specialized fast track clinics has been suggested to reduce the rate of visual ischaemic complications and associated costs. In other LVV such as Takayasu arteritis and chronic periaortitis, the diagnostic accuracy in comparison to other noninvasive imaging methods has not been formally tested but can be considered to be excellent. However, quality of US is highly dependent on the operator's experience, and assessment of the thoracic aorta which is frequently involved in GCA and TA is limited. The role of US in the followup of LVV under treatment is unclear. In view of the promising data supporting its value on the one hand and several uncertainties and controversies on the other hand, the present review article provides a comprehensive overview on current evidence for the application of US in the diagnosis and follow up of LVV. Recent multicentre study results and emerging trends such as the application of compression sonography in the diagnosis of GCA and the use of contrast enhanced ultrasound in disease activity assessment in Takayasu arteritis are discussed.

Vascular ultrasound for monitoring of inflammatory activity in Takayasu arteritis

“…Vessel wall changes in inflammatory disease could be evaluated by CT scan, arterial angiography, MRI, PET and combined PET-CT-scan (Ammirati et al, 2014). Using DUS, resolution theoretically is superior, at least at high ultrasound frequencies (Schmidt & Gromnica-Ihle, 2005;Schmidt, 2014;Czihal et al, 2017). DUS may be used for frequent controls because of ease, no radiation and low costs.…”

“…In TA, Duplex ultrasound (DUS) seems to be a reliable tool for characterization of inflammation in the vessel wall and for monitoring of hemodynamic changes in response to therapy (Sun et al, 1996;Czihal et al, 2017;Germano et al, 2017a;Germano et al, 2017b). In active TA, DUS detects characteristic long segments with homogenous, mid-echogenic circumferential (prominent) arterial wall thickening, the 'Macaroni sign' (Maeda et al, 1991).…”

Vaskulitiden in der Gefäßmedizin

“…erforderlich. Die Untersuchung der Schultergürtelgefäße ist nicht sehr aufwendig und sollte bei der Abklärung des Fiebers unklarer Genese stärker in die Diagnostik einbezogen werden als bisher [8]. Die Riesenzellarteriitis istnach Infekten und Malignomeneine der häufigsten Ursachen eines solchen Fiebers unklarer Genese.…”

“…1 Befallsmuster bei der Takayasu-Arteriitis nach der Konsensuskonferenz Singapur im Jahr 1995 [14]. Merke Große Bedeutung hat bei der Diagnostik der Takayasu-Arteriitis die Ultraschalluntersuchung der Gefäße [8].…”

Facial pain from various sources-diagnoses and differential diagnoses

“…The artery will often show inflammation that includes abnormally large cells, called giant cells. MRA, PET scan and Doppler or ultrasound also can help confirm the vascular nature of the disorder [11]. If the diagnosis of temporal arteritis is suspected, immediately start high dose prednisone to prevent vision loss, even before test results are available, and continue for one to two years.…”