Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy.
RMD Open. 2023 Aug;9(3). doi: 10.1136/rmdopen-2023-003379.
To update the evidence on imaging for diagnosis, monitoring and outcome prediction in large vessel vasculitis (LVV) to inform the 2023 update of the European Alliance of Associations for Rheumatology recommendations on imaging in LVV.
Systematic literature review (SLR) (2017-2022) including prospective cohort and cross-sectional studies (>20 participants) on diagnostic, monitoring, outcome prediction and technical aspects of LVV imaging. Diagnostic accuracy data were meta-analysed in combination with data from an earlier (2017) SLR.
The update retrieved 38 studies, giving a total of 81 studies when combined with the 2017 SLR. For giant cell arteritis (GCA), and taking clinical diagnosis as a reference standard, low risk of bias (RoB) studies yielded pooled sensitivities and specificities (95% CI) of 88% (82% to 92%) and 96% (95% CI 86% to 99%) for ultrasound (n=8 studies), 81% (95% CI 71% to 89%) and 98% (95% CI 89% to 100%) for MRI (n=3) and 76% (95% CI 67% to 83%) and 95% (95% CI 71% to 99%) for fluorodeoxyglucose positron emission tomography (FDG-PET, n=4), respectively. Compared with studies assessing cranial arteries only, low RoB studies with ultrasound assessing both cranial and extracranial arteries revealed a higher sensitivity (93% (95% CI 88% to 96%) vs 80% (95% CI 71% to 87%)) with comparable specificity (94% (95% CI 83% to 98%) vs 97% (95% CI 71% to 100%)). No new studies on diagnostic imaging for Takayasu arteritis (TAK) were found. Some monitoring studies in GCA or TAK reported associations of imaging with clinical signs of inflammation. No evidence was found to determine whether imaging severity might predict worse clinical outcomes.
Ultrasound, MRI and FDG-PET revealed a good performance for the diagnosis of GCA. Cranial and extracranial vascular ultrasound had a higher pooled sensitivity with similar specificity compared with limited cranial ultrasound.
更新大血管血管炎（LVV）诊断、监测和预后预测的影像学证据，为 2023 年欧洲风湿病协会联盟关于 LVV 影像学建议的更新提供信息。
系统文献回顾（SLR）（2017-2022 年），包括关于诊断、监测、预后预测和 LVV 影像学技术方面的前瞻性队列研究和横断面研究（>20 名参与者）。将诊断准确性数据与早期（2017 年）SLR 的数据进行合并分析。
更新检索到 38 项研究，与 2017 年 SLR 结合，总共 81 项研究。对于巨细胞动脉炎（GCA），以临床诊断为参考标准，低偏倚风险（RoB）研究得出超声检查的汇总敏感性和特异性（95%CI）分别为 88%（82%至 92%）和 96%（95%CI 86%至 99%）（n=8 项研究），磁共振成像（MRI）为 81%（95%CI 71%至 89%）和 98%（95%CI 89%至 100%）（n=3 项研究），氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）为 76%（95%CI 67%至 83%）和 95%（95%CI 71%至 99%）（n=4 项研究）。与仅评估颅动脉的研究相比，低 RoB 研究使用超声评估颅内外动脉，其敏感性更高（93%（95%CI 88%至 96%）与 80%（95%CI 71%至 87%）），特异性相似（94%（95%CI 83%至 98%）与 97%（95%CI 71%至 100%））。未发现新的 Takayasu 动脉炎（TAK）诊断影像学研究。一些 GCA 或 TAK 的监测研究报告了影像学与炎症临床体征之间的关联。没有证据表明影像学严重程度可能预示着更差的临床结局。
超声、MRI 和 FDG-PET 对 GCA 的诊断具有良好的性能。与有限的颅超声检查相比，颅内外血管超声检查具有更高的汇总敏感性和相似的特异性。
