Multimodality Imaging of Large-Vessel Vasculitis, From the AJR Special Series on Inflammation.

ABSTRACT

Large-vessel vasculitis (LVV) is a noninfectious inflammation of the large vessels, including the aorta and its main branches. Imaging plays an essential role in diagnosing LVV given the challenges of tissue biopsy. This article reviews the types of LVV and the multimodality imaging tools available to establish its diagnosis. The cornerstone of imaging diagnosis is morphologic assessment using gray-scale ultrasound (US), gray-scale US combined with color Doppler US, CTA, or MRA. In the last decade, substantial progress has been made in functional and molecular imaging with FDG PET/CT for the diagnosis of LVV. Investigation is ongoing to develop novel MRA techniques and new PET tracers to assess disease activity and to differentiate the various vasculitides. An algorithm is provided to guide imaging technique selection based on the patient's specific clinical presentation.