Imaging inflammatory Large Vessel Vasculitides (LVV)

Young lady (22 years) came to the vascular surgery clinic with low-grade fever, loss of weight, body pains, tenderness in the carotid triangle and weak radial pulsations in both the hands. There were no vascular risk factors or joint pains. Giant-cell arteritis (GCA) and Takayasu’s arteritis (TA) are the commonest large-vessel vasculitides (LVV) in such patients. Imaging studies are increasingly being used to diagnose and to monitor LVV. The aim of this presentation is to discuss a case and review the literature on imaging studies.

Imaging studies play a central role in diagnosing and monitoring the large vessel vasculitides (giant-cell and Takayasu’s arteritis). CT or MRI, TEE can examine the deep and central large vessels, while color Doppler ultrasound and MRI have been used with promising results to investigate the temporal arteries. Positron emission tomography is very sensitive in detecting large-vessel inflammation, although it does not delineate the vessel wall. Imaging procedures can also be used to monitor the disease course. However, imaging signs of inflammation may sometimes persist despite clinical remission and, conversely, seemingly unaffected vessels may develop alterations later on. The commonest angiographic findings in Takayasu’s disease are long, smooth vascular stenoses and sometimes occlusions and aneurysms. However, angiography cannot demonstrate early vasculitic lesions such as vessel wall alterations and is thus not useful for early diagnosis.