Casteleyn Vincent, Schmidt Wolfgang Andreas
Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Deutschland.
Abteilung Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Standort Berlin-Buch, Lindenberger Weg 19, 13125, Berlin, Deutschland.
Z Rheumatol. 2023 Oct;82(8):646-653. doi: 10.1007/s00393-023-01405-7. Epub 2023 Aug 24.
Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are the most important primary large vessel vasculitides. A rapid and reliable confirmation of the diagnosis is necessary to prevent ischemic complications. Patients with extracranial GCA and TAK often present with unspecific symptoms. Since 2018 the EULAR has recommended imaging as an alternative to histology for confirming the diagnosis. Ultrasound is particularly recommended as the primary imaging modality for cranial GCA. Alternatively, MRI and PET can be used for the diagnostics of temporal arteritis. Ultrasound is also valuable for extracranial GCA, alternatively MRI, CT or PET-CT can be used. This review discusses the current status of imaging techniques in large vessel vasculitis as well as the advantages and disadvantages. The focus is on ultrasound, which is increasingly being used as the primary diagnostic modality due to its excellent diagnostic quality, wide availability, noninvasiveness, and patient friendliness. Technical aspects, prerequisites, and normal and pathological findings are also presented. Finally, an outlook is given on promising new developments, such as scores for evaluating disease progression and contrast-enhanced ultrasound.
巨细胞动脉炎(GCA)和大动脉炎(TAK)是最重要的原发性大血管血管炎。为预防缺血性并发症,快速且可靠地确诊很有必要。颅外GCA和TAK患者常表现出非特异性症状。自2018年起,欧洲抗风湿病联盟(EULAR)推荐将影像学检查作为组织学检查的替代方法用于确诊。特别推荐超声作为颅部GCA的主要影像学检查方式。另外,MRI和PET可用于颞动脉炎的诊断。超声对颅外GCA也很有价值,也可使用MRI、CT或PET-CT。本综述讨论了大血管血管炎中成像技术的现状以及优缺点。重点是超声,由于其出色的诊断质量、广泛可用性、非侵入性和对患者的友好性,它越来越多地被用作主要诊断方式。还介绍了技术方面、前提条件以及正常和病理表现。最后,展望了有前景的新进展,如评估疾病进展的评分和超声造影。