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Abstract Number: 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

Meeting: ACR Convergence 2023

Keywords: giant cell arteritis, Imaging, Magnetic resonance imaging (MRI), Takayasu.s arteritis, Ultrasound

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Session Information

Date: Monday, November 13, 2023

Title: Abstracts: Vasculitis – Non-ANCA-Associated & Related Disorders I: Imaging

Session Type: Abstract Session

Session Time: 2:00PM-3:30PM

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.

Supporting image 1

Table 1. Recommendations for the use of imaging in large vessel vasculitis in clinical practice


Disclosures: 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.

To cite this abstract in AMA style:

Dejaco C, Ramiro S, Bond M, Bosch P, Ponte C, Mackie S, Bley T, Blockmans D, Brolin S, Bolek E, Cassie R, Cid M, Molina-Collada J, Dasgupta B, Dalsgaard Nielsen B, De Miguel E, Direskeneli H, Duftner C, Hocevar A, Molto A, Schäfer V, Seitz L, Slart R, Schmidt W. EULAR Recommendations for the Use of Imaging in Large Vessel Vasculitis in Clinical Practice: 2023 Update [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/eular-recommendations-for-the-use-of-imaging-in-large-vessel-vasculitis-in-clinical-practice-2023-update/. Accessed .
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