Vasculitis & polymyalgia rheumatica
Imaging in diagnosis, monitoring and outcome prediction of large vessel vasculitis: a systematic literature review and meta-analysis informing the 2023 update of the EULAR recommendations
Authors' conclusion
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.
Study context
- Population
- Studies on imaging for diagnosis, monitoring and outcome prediction in large vessel vasculitis (LVV) (giant cell arteritis (GCA), TAK)81 studies
- Comparison
- Ultrasound vs MRI vs fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis of GCA
- Outcome
- Diagnostic accuracy (pooled sensitivity and specificity) of imaging for GCA, clinical diagnosis as reference standard
Methodological detailsprospective cohort and cross-sectional studies (>20 participants), 2017-2022 update combined with 2017 systematic literature review (SLR), diagnostic accuracy meta-analysis
- Prospective cohort and cross-sectional studies (>20 participants)
- 2017-2022 update combined with 2017 SLR
- Diagnostic accuracy meta-analysis
Pooled result
As reported in the abstract
Pooled sensitivity and specificity for GCA (low RoB studies)
| Group | Sensitivity | Specificity |
|---|---|---|
| Ultrasound | 88% (82% to 92%)Sensitivity on a scale from 0 to 100 percent | 96% (95% CI 86% to 99%)Specificity on a scale from 0 to 100 percent |
| MRI | 81% (95% CI 71% to 89%)Sensitivity on a scale from 0 to 100 percent | 98% (95% CI 89% to 100%)Specificity on a scale from 0 to 100 percent |
| FDG-PET | 76% (95% CI 67% to 83%)Sensitivity on a scale from 0 to 100 percent | 95% (95% CI 71% to 99%)Specificity on a scale from 0 to 100 percent |
Sensitivity
Ultrasound88% (82% to 92%)
MRI81% (95% CI 71% to 89%)
FDG-PET76% (95% CI 67% to 83%)
Sensitivity on a scale from 0 to 100 percentSpecificity
Ultrasound96% (95% CI 86% to 99%)
MRI98% (95% CI 89% to 100%)
FDG-PET95% (95% CI 71% to 99%)
Specificity on a scale from 0 to 100 percentFurther pooled results
| Outcome | Cranial + extracranial US | Cranial-only US |
|---|---|---|
| US sensitivity and specificity: cranial + extracranial vs cranial-only arteries | ||
| Sensitivity | 93% (95% CI 88% to 96%) | 80% (95% CI 71% to 87%) |
| Specificity | 94% (95% CI 83% to 98%) | 97% (95% CI 71% to 100%) |
US sensitivity and specificity: cranial + extracranial vs cranial-only arteries
- Higher sensitivity with comparable specificity
Diagnostic imaging for TAK
- No new studies found
Monitoring in GCA or TAK
- Some studies reported associations of imaging with clinical signs of inflammation
Outcome prediction by imaging severity
- No evidence found
Original publication
Imaging in diagnosis, monitoring and outcome prediction of large vessel vasculitis: a systematic literature review and meta-analysis informing the 2023 update of the EULAR recommendations. RMD Open. Published 24 August 2023. doi:10.
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