1648: EULAR Recommendations for the Use of Imaging in Large Vessel Vasculitis in Clinical Practice: 2023 Update

Christian Dejaco¹, Sofia Ramiro², Milena Bond³, Philipp Bosch⁴, Cristina Ponte⁵, Sarah Mackie⁶, Thorsten Bley⁷, Daniel Blockmans⁸, Sara Brolin⁹, Ertugrul Cagri Bolek¹⁰, Rebecca Cassie¹¹, Maria C Cid¹², Juan Molina-Collada¹³, Bhaskar Dasgupta¹⁴, Berit Dalsgaard Nielsen¹⁵, Eugenio De Miguel¹⁶, Haner Direskeneli¹⁷, Christina Duftner¹⁸, Alojzija Hocevar¹⁹, Anna Molto²⁰, Valentin Sebastian Schäfer²¹, Luca Seitz²², Riemer H.J.A. Slart²³ and Wolfgang Schmidt²⁴, ¹Azienda Sanitaria Alto Adige, Brunico, Italy, ²Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ³Azienda sanitaria dell'Alto Adige, Merano, Italy, ⁴Medical University of Graz, Graz, Austria, ⁵Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal, ⁶Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, ⁷Institute of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany, ⁸Department of General Internal Medicine, University Hospitals Leuven, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium, ⁹Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden, ¹⁰1-Hacettepe University Vasculitis Research Centre, Ankara, Turkey/ 2-Vasculitis Translational Research Program, NIAMS, NIH, US, Ankara, Turkey, ¹¹n/a, Leicester, United Kingdom, ¹²Hospital Clinic Barcelona, Barcelona, Spain, ¹³Hospital General Universitario Gregorio Marañón, Madrid, Spain, ¹⁴Mid & South Essex University Hospitals NHS Foundation Trust; Southend University Hospital, Westcliff-on-sea, United Kingdom, ¹⁵Department of Internal Medicine, Horsens, Denmark, ¹⁶Hospital Universitario La Paz, Madrid, Spain, ¹⁷Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey, ¹⁸Medical University Innsbruck, Innsbruck, Austria, ¹⁹Department of Rheumatology, Universitiy Medical Centre Ljubljana, Ljubljana, Slovenia, ²⁰HOPITAL COCHIN AP-HP, Service de Rhumatologie, Paris, France, ²¹Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, Bonn, Germany, ²²Rheumatology and Immunology, Inselspital University Hospital Bern, Bern, Switzerland, ²³University of Twente, Enschede, Netherlands, ²⁴Rheumatology, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany

Background/Purpose: 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. The objective of this project was 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.




C. Dejaco: AbbVie/Abbott, 2, 5, 6, Amgen, 6, Eli Lilly, 2, 6, Galapagos Pharma, 2, 6, Janssen, 1, Novartis, 2, 5, 6, Pfizer, 6, Sparrow, 2; S. Ramiro: AbbVie, 2, 5, Eli Lilly, 2, Galapagos, 5, MSD, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, Sanofi, 2, UCB Pharma, 2, 5; M. Bond: AbbVie/Abbott, 5; P. Bosch: Janssen, 6, 12, Congress fees, Pfizer, 5; C. Ponte: None; S. Mackie: AbbVie/Abbott, 2, AstraZeneca, 2, GlaxoSmithKlein(GSK), 3, 12, Investigator, National Institute for Health and Care Research, 5, 12, investigator on STERLING-PMR trial, funded by NIHR; patron of the charity PMRGCAuk, Pfizer, 2, 6, Roche, 2, 6, 12, Support from Roche/Chugai to attend EULAR2019 in person, Sanofi, 2, 12, Investigator, Sparrow, 12, Investigator, UCB and Novartis, 6, Vifor, 6; T. Bley: None; D. Blockmans: None; S. Brolin: Novartis, 5; E. Bolek: None; R. Cassie: None; M. Cid: AbbVie/Abbott, 1, 2, 6, AstraZeneca, 1, GSK, 1, 2, 6, Kininksa Pharmaceutical, 5, SCL-Vifor, 2, 6; J. Molina-Collada: None; B. Dasgupta: AbbVie/Abbott, 2, 5, Chugai, 2, 5, Novartis, 2, 5, Roche, 2, 5, Sanofi, 2, 5; B. Dalsgaard Nielsen: None; E. De Miguel: None; H. Direskeneli: AbbVie/Abbott, 1, 5, 6, Amgen, 6, celltrione, 1, 6, Pfizer, 5, 6, Roche, 12, Educational, UCB, 5, 6, 12, Educational; C. Duftner: Abbvie, 2, 6, AOP Orphan, 2, 6, AstraZeneca, 2, 6, Bristol-Myers Squibb(BMS), 2, 6, Eli Lilly, 2, 5, 6, Galapagos Pharma, 2, 6, Janssen, 2, 6, Merck/MSD, 2, 6, Novartis, 2, 6, Pfizer, 2, 5, 6, Roche, 2, 6, Sandoz, 2, 6, UCB, 2, 5, 6, Vifor, 2, 6; A. Hocevar: None; A. Molto: None; V. Schäfer: None; L. Seitz: None; R. Slart: None; W. Schmidt: AbbVie/Abbott, 1, 5, 6, Amgen, 1, 6, Bristol-Myers Squibb(BMS), 6, Chugai, 6, GlaxoSmithKlein(GSK), 1, 5, 6, Janssen, 6, Medac, 6, Novartis, 1, 5, 6, Roche, 6, UCB, 6.