LB0009 EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update

Background

Imaging recommendations for primary large vessel vasculitis (LVV) were developed in 2018. Several new studies have emerged since then, and an update of the original statements was required.

Objectives

To update the recommendations for the use of imaging in LVV.

Methods

A systematic literature review update was performed to retrieve new evidence on ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) and [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis, monitoring and outcome prediction in LVV. The task force consisted of 24 physicians, health professionals and patients from 14 countries.

Results

Three overarching principles and eight recommendations were agreed (Table 1). Compared to the 2018 version, US is now recommended as first line imaging test in all patients with suspected GCA, and axillary arteries should be included in the standard examination. As an alternative to US, cranial and extracranial arteries can be examined by FDG-PET or MRI. For Takayasu arteritis, MRI is the preferred imaging modality; CT or FDG-PET are alternatives. Although imaging is not routinely recommended for follow-up, US, FDG-PET or MRI may be used for assessing vessel abnormalities in LVV patients with suspected relapse, particularly when laboratory markers of inflammation are unreliable. MRA, CTA or US may be used for long-term monitoring of structural damage, particularly at sites of preceding vascular inflammation.

Conclusion

The 2023 recommendations provide up-to-date guidance for the role of imaging in the diagnosis and assessment of patients with (suspected) LVV.

References

NIL.

Acknowledgments

Funding provided by EULAR (Project number: QoC13). We would like to thank Louise Falzon for her help with the literature search strategy. We also thank Lorna Neill, Luca Cimino and Fabrizio Gozzi for their help with the update of the PICO questions.

Disclosure of Interests

Christian Dejaco Consultant of: AbbVie, Novartis, Janssen, Sanofi, Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Grant/research support from: AbbVie, Sofia Ramiro Consultant of: AbbVie, Eli Lilly, Galapagos, MSD, Novartis, Pfizer, Sanofi, UCB, Speakers bureau: AbbVie, Eli Lilly, Galapagos, MSD, Novartis, Pfizer, Sanofi, UCB, Grant/research support from: AbbVie, Eli Lilly, Galapagos, MSD, Novartis, Pfizer, Sanofi, UCB, Milena Bond Consultant of: AbbVie, Philipp Bosch Speakers bureau: Janssen, Grant/research support from: Pfizer, Cristina Ponte Consultant of: AbbVie, Sanofi, Novartis, Vifor, AstraZeneca, GlaxoSmithKline, and Roche, Speakers bureau: Vifor, AstraZeneca, GlaxoSmithKline, and Roche, Sarah Mackie Consultant of: Roche/Chugai, Sanofi, AbbVie, AstraZeneca, Sanofi, GSK, Sparrow, Speakers bureau: Roche/Chugai, Vifor, Pfizer and Novartis, Torsten Bley Consultant of: BioTel Research, Chugai, Guerbet, Novartis, Roche and Siemens Healthineers, Speakers bureau: BioTel Research, Chugai, Guerbet, Novartis, Roche, Sanofi and Siemens Healthineers, Daniel Blockmans Consultant of: Roche and GSK, Sara Brolin Grant/research support from: Novartis, Ertugrul Cagri Bolek: None declared, Rebecca Cassie: None declared, Maria C. Cid Consultant of: GSK, SCL-Vifor, AbbVie, AstraZeneca and Janssen, Grant/research support from: Kiniksa Pharmaceuticals, Juan Molina Collada Consultant of: Abbvie, Lilly, Janssen, Novartis, Pfizer, UCB, MSD, Speakers bureau: Abbvie, Lilly, Janssen, Novartis, Pfizer, UCB, MSD, Bhaskar Dasgupta Consultant of: Novartis, Abbvie,Roche,Chugai,Sanofi, Grant/research support from: Novartis, Abbvie,Roche,Chugai,Sanofi, Berit Dalsgaard NIelsen Consultant of: Roche and Novartis, Speakers bureau: Roche and Novartis, Eugenio de Miguel Consultant of: Novartis, AbbVie, Pfizer, Janssen, Lilly, Speakers bureau: Abbvie, Novartis, Pfizer, Roche, Janssen, Lilly, MSD, BMS, UCB, Grunental and Sanofi, Grant/research support from: Novartis, AbbVie, Pfizer, Janssen, Lilly, Haner Direskeneli Consultant of: Abbvie and Novartis, Grant/research support from: Pfizer, Amgene, Celltrion, UCB and Roche, Christina Duftner Consultant of: Abbvie, AOP Orphan, Astra-Zeneca, Bristol-Myers-Squibb, Eli-Lilly, Janssen, Galapagos, Merck-Sharp-Dohme, Novartis, Pfizer, Roche, Sandoz, UCB, Vifor, Speakers bureau: Abbvie, AOP Orphan, Astra-Zeneca, Bristol-Myers-Squibb, Eli-Lilly, Janssen, Galapagos, Merck-Sharp-Dohme, Novartis, Pfizer, Roche, Sandoz, UCB, Vifor, Grant/research support from: Eli-Lilly, Pfizer, UCB, ALOJZIJA HOCEVAR: None declared, Anna Moltó Consultant of: AbbVie, BMS, Biogen, Eli Lilly, Galapagos, Janssen, MSD, Novartis, and UCB, Grant/research support from: AbbVie, BMS, Biogen, Eli Lilly, Galapagos, Janssen, MSD, Novartis, and UCB, Valentin Schäfer: None declared, Luca Seitz Grant/research support from: iQone and Sandoz, Riemer Slart Grant/research support from: Siemens Healtineers and Pfizer, Wolfgang Schmidt Consultant of: Abbvie, Chugai, GlaxoSmithKline, Medac, Novartis, Roche, and Sanofi, Speakers bureau: Abbvie, Chugai, GlaxoSmithKline, Medac, Novartis, Roche, and Sanofi.