New imaging strategy for large vessel vasculitis (based on the EULAR-2023 recommendations)

Large vessel vasculitis (LVV), including Takayasu's arteritis (AT, or non-specific aortoarteritis) and giant cell arteritis (GCA), is caused by granulomatous inflammation affecting mainly the aorta and its main branches. Damage to the vascular wall leads to ischemia of the corresponding organs and can be complicated by loss of vision, cerebral insufficiency and other life-threatening phenomena. The early diagnosis of these diseases in clinical practice is a difficult task that can only be solved by comparing the clinical symptoms, the results of the physical, laboratory and instrumental examination and the vascular biopsy.A comparative analysis of the 2018 and 2023 EULAR recommendations for imaging in LVV is presented. Duplex ultrasound (USDS) of not only temporal but also axillary arteries is recommended for GCA and magnetic resonance imaging (MRI) for AT. Alternative methods for GCA are MRI or positron emission tomography (PET) in combination with computed tomography (CT) and intravenous administration of fluorodeoxyglucose labelled with the short-lived fluoride isotope 18 (FDG-PET/CT), and for AT – FDG-PET/CT, CT or ultrasound examination. MRI, CT or ultrasound can be used for long-term monitoring of structural damage, especially to assess pre-existing vascular inflammation.