Imaging for Diagnosis, Monitoring and Outcome Prediction of Large Vessel Vasculitis: A Systematic Review of the Literature and Meta-Analysis Informing the EULAR Recommendations

Christina Duftner¹, Christian Dejaco², Alexandre Sepriano³, Louise Falzon⁴, Wolfgang A. Schmidt⁵ and Sofia Ramiro⁶, ¹Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria, ²Rheumatology, Hospital of Bruneck, Bruneck, Italy, ³Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ⁴Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, ⁵Medical Center for Rheumatology and Clinical Immunology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany, ⁶Rheumatology, Department of Rheumatology, LUMC, Leiden, Netherlands, Leiden, Netherlands

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: giant cell arteritis, Imaging, large vessel vasculitis and takayasu arteritis

Session Information

Date: Sunday, November 5, 2017

Title: Imaging of Rheumatic Diseases Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Modern imaging techniques including ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) and ¹⁸F-FDG positron emission tomography (PET) are increasingly studied in large vessel vasculitis (LVV); however, their role in daily clinical practice remains elusive so far. The aim of this study was to perform a systematic literature review (SLR) to inform the EULAR recommendations for imaging in LVV on the role of imaging methods on (1) diagnosis, (2) disease monitoring, (3) outcome prediction and (4) technical aspects in LVV

Methods: A systematic literature search was conducted in the MEDLINE, EMBASE and Cochrane Library databases (untill 10^th March 2017) without language restriction. Full research articles of prospective studies enrolling >20 patients and investigating the index test (US, MRI, CT, PET) in patients with suspicion of (diagnostic studies) and/or established (studies on monitoring or prediction) primary LVV were selected. The risk of bias for diagnostic accuracy and prognostic studies were evaluated by the QUADAS2 and QUIPS tools, respectively. Meta-analysis was conducted, whenever possible, to obtain pooled estimates for sensitivity, specificity, positive and negative likelihood ratios, by fitting random effects models.

Results: Forty-four studies were included [27 diagnosis giant cell arteritis (GCA), 6 outcome prediction GCA, 15 monitoring disease activity GCA, 5 technical aspects GCA, 2 diagnosis Takayasu arteritis (TAK), 2 monitoring disease activity TAK with some studies addressing more than one index test/key objective]. The “halo” sign at temporal arteries, as identified by US (8 studies, 605 patients), yielded a pooled sensitivity of 77% (95% CI: 62-87%) and a pooled specificity of 96% (95% CI: 85-99%) as compared to clinical diagnosis of GCA. MRI of extra-cranial arteries was found to have a pooled sensitivity of 73% (95% CI: 57-85) and a pooled specificity of 88% (95% CI: 81-92), when clinical diagnosis (6 studies, 509 patients) was used as gold standard. For both, US and MRI, similar diagnostic performances were observed when temporal artery biopsy was used as reference standard instead of clinical diagnosis. Only 2 studies (93 patients) addressed the diagnostic accuracy of PET in GCA reporting sensitivities of 67-77% and specificities of 66-100%. Studies addressing the role of imaging for outcome prediction, monitoring disease activity and technical aspects were very heterogenous. For TAK, 1 MRI (30 patients) and CT angiography study (25 patients) was identified revealing both a sensitivity of 98% and a specificity of 100% in comparison to conventional angiography. No study on isolated aortitis was identified.

Conclusion: The SLR confirms the good performance of US and MRI for the diagnosis of cranial GCA. Data on outcome prediction, monitoring and technical aspects of GCA, as well as imaging studies in TAK are limited.

Disclosure: C. Duftner, None; C. Dejaco, None; A. Sepriano, None; L. Falzon, None; W. A. Schmidt, None; S. Ramiro, None.

To cite this abstract in AMA style:

Duftner C, Dejaco C, Sepriano A, Falzon L, Schmidt WA, Ramiro S. Imaging for Diagnosis, Monitoring and Outcome Prediction of Large Vessel Vasculitis: A Systematic Review of the Literature and Meta-Analysis Informing the EULAR Recommendations [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/imaging-for-diagnosis-monitoring-and-outcome-prediction-of-large-vessel-vasculitis-a-systematic-review-of-the-literature-and-meta-analysis-informing-the-eular-recommendations/. Accessed .

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