Large-Vessel Vasculitis: Multimodality Imaging Essentials

A practical radiology review of Large-Vessel Vasculitis: Multimodality Imaging Essentials, focused on imaging findings, differential diagnosis, reporting points, and high-yield teaching pearls.

Big Picture

• Imaging = cornerstone of diagnosis (often replaces biopsy).
• Multimodality approach (US + CTA/MRA + PET) is essential.
• Inflammation ≠ stenosis → functional changes can precede anatomy.
• Labs and symptoms are nonspecific → imaging drives decisions.

Core Entities

Giant Cell Arteritis (GCA): age > 50, female > male, cranial ± extracranial, risk = visual loss, stroke.

• Takayasu Arteritis (TA): age < 40, female ≫ male, aorta and branches, risk = stenosis, occlusion, aneurysm, silent CAD.
• Guideline Pearls
• EULAR: US first line for GCA, MRI/MRA first line for TA, imaging can replace biopsy.
• ACR: temporal artery biopsy still favored (US operator dependent).
• Catheter angiography → obsolete and unsafe.
• Ultrasound (US) — HIGH YIELD SIGNS