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Original article
Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and meta-analysis informing the EULAR recommendations
  1. Christina Duftner1,
  2. Christian Dejaco2,3,
  3. Alexandre Sepriano4,5,
  4. Louise Falzon6,
  5. Wolfgang Andreas Schmidt7 and
  6. Sofia Ramiro4
  1. 1 Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
  2. 2 Rheumatology Service, South Tyrolean Health Trust, Hospital of Bruneck, Bruneck, Italy
  3. 3 Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria
  4. 4 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  5. 5 NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
  6. 6 Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, New York, USA
  7. 7 Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
  1. Correspondence to Dr Christina Duftner; christina.duftner{at}gmx.at

Abstract

Objectives To 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.

Methods Systematic 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.

Results Forty-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.

Conclusions Ultrasound 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.

  • giant cell arteritis
  • ultrasonography
  • magnetic resonance imaging

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • ChristinD and ChristiaD are first co-authors.

  • Contributors Study concept and design: ChristinD, ChristiaD, SR and WAS; data collection: ChristinD and ChristiaD; statistical analysis and data interpretation: AS, ChristinD, ChristiaD, SR and WAS; ChristinD prepared the first version of the manuscript. All authors revised the manuscript critically for important intellectual content and gave final approval of the version to be published.

  • Funding Funding was provided by the European League Against Rheumatism.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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