Vasculitis syndromes: Edited by Phil SeoImaging for large-vessel vasculitisBlockmans, Daniela; Bley, Thorstenb,c; Schmidt, Wolfgangd Author Information aGeneral Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium bDepartment of Radiology, University of Wisconsin, Madison, USA cDepartment of Diagnostic Radiology, University Hospital Freiburg, Freiburg dMedical Center for Rheumatology Berlin-Buch, Berlin, Germany Correspondence to Prof Dr D. Blockmans, Dienst Algemeen Inwendige Geneeskunde, UZ Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium Tel: +32 16 344279; fax: +32 16 344230; e-mail: [email protected] Current Opinion in Rheumatology 21(1):p 19-28, January 2009. | DOI: 10.1097/BOR.0b013e32831cec7b Buy Metrics Abstract Purpose of review Ultrasonography, MRI, and PET are increasingly studied in large-vessel vasculitis. They have broadened our knowledge on these disorders and have a place in the diagnostic approach of these patients. Recent findings Temporal artery ultrasonography can be used to guide the surgeon to that artery segment with the clearest ‘halo’ sign to perform a biopsy, or in experienced hands can even replace biopsy. The distal subclavian, axillary, and brachial arteries can also be examined. High-resolution MRI depicts superficial cranial and extracranial involvement patterns in giant cell arteritis (GCA). Contrast enhancement is prominent in active inflammation and decreases under successful steroid therapy. Presence of aortic complications such as aneurysm or dissection can be ruled out within the same investigation. Large thoracic vessel FDG-uptake is seen in the majority of patients with GCA, especially at the subclavian arteries and the aorta. FDG-PET cannot predict which patients are bound to relapse, and once steroids are started, interpretation is hazardous, which makes its role in follow-up uncertain. Increased thoracic aortic FDG-uptake at diagnosis of GCA may be a bad prognostic factor for later aortic dilatation. In patients with isolated polymyalgia rheumatica – who have less intense vascular FDG uptake – symptoms are caused by inflammation around the shoulders, hips, and spine. Summary Ultrasonography, MRI, and PET remain promising techniques in the scientific and clinical approach of large-vessel vasculitis. © 2009 Lippincott Williams & Wilkins, Inc.