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Large Vessel Vasculitis
James Patrick Davidson, MD; Paige Bennett, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Large vessel vasculitis: Autoimmune-mediated inflammation of aorta and major branch vessels; leukocytes invade and damage vessel walls; bleeding, loss of vessel integrity leads to morbidity
            • Giant cell arteritis
              • a.k.a. temporal arteritis, as it often affects carotid artery branches (including superficial temporal artery)
              • Seen in patients > 50 years old
            • Takayasu arteritis
              • Often localized to portions of aorta/branch vessels
              • Seen in patients < 30 years old
            • Others: Idiopathic isolated aortitis, those associated with systemic vasculitis syndromes

        IMAGING

        • F-18 FDG PET/CT Findings

          DIFFERENTIAL DIAGNOSIS

            PATHOLOGY

            • General Features

              CLINICAL ISSUES

              • Presentation

                • Demographics

                  • Natural History & Prognosis

                    • Treatment

                      Selected References

                      1. de Boysson H et al: 18F-fluorodeoxyglucose positron emission tomography and the risk of subsequent aortic complications in giant-cell arteritis: a multicenter cohort of 130 patients. Medicine (Baltimore). 95(26):e3851, 2016
                      2. Muratore F et al: Imaging of vasculitis: state of the art. Best Pract Res Clin Rheumatol. 30(4):688-706, 2016
                      3. Alibaz-Oner F et al: Advances in the diagnosis, assessment and outcome of Takayasu's arteritis. Clin Rheumatol. 32(5):541-6, 2013
                      4. Cohen Tervaert JW: What to do when you suspect your patient suffers from pulmonary vasculitis? Expert Opin Med Diagn. 7(1):1-4, 2013
                      5. Martínez-Rodríguez I et al: Comparison of early (60 min) and delayed (180 min) acquisition of 18F-FDG PET/CT in large vessel vasculitis. Rev Esp Med Nucl Imagen Mol. 32(4):222-6, 2013
                      6. Pacheco Castellanos Mdel C et al: Early diagnosis of large vessel vasculitis: usefulness of positron emission tomography with computed tomography. Reumatol Clin. 9(1):65-8, 2013
                      7. Fuchs M et al: The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging. 39(2):344-53, 2012
                      8. Papathanasiou ND et al: 18F-Fludeoxyglucose PET/CT in the evaluation of large-vessel vasculitis: diagnostic performance and correlation with clinical and laboratory parameters. Br J Radiol. 85(1014):e188-94, 2012
                      9. Blockmans D: PET in vasculitis. Ann N Y Acad Sci. 1228:64-70, 2011
                      10. James OG et al: Utility of FDG PET/CT in inflammatory cardiovascular disease. Radiographics. 31(5):1271-86, 2011
                      11. Lamare F et al: Detection and quantification of large-vessel inflammation with 11C-(R)-PK11195 PET/CT. J Nucl Med. 52(1):33-9, 2011
                      12. Lehmann P et al: 18F-FDG PET as a diagnostic procedure in large vessel vasculitis-a controlled, blinded re-examination of routine PET scans. Clin Rheumatol. 30(1):37-42, 2011
                      13. Treglia G et al: Usefulness of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography in patients with large-vessel vasculitis: a systematic review. Clin Rheumatol. 30(10):1265-75, 2011
                      14. Castañer E et al: When to suspect pulmonary vasculitis: radiologic and clinical clues. Radiographics. 30(1):33-53, 2010
                      15. Pugliese F et al: Imaging of vascular inflammation with [11C]-PK11195 and positron emission tomography/computed tomography angiography. J Am Coll Cardiol. 56(8):653-61, 2010
                      16. Stenová E et al: FDG-PET/CT in large-vessel vasculitis: its diagnostic and follow-up role. Rheumatol Int. 30(8):1111-4, 2010
                      17. Zerizer I et al: Role of FDG-PET and PET/CT in the diagnosis and management of vasculitis. Eur J Radiol. 73(3):504-9, 2010
                      18. Meller J et al: FDG-PET in patients with fever of unknown origin: the importance of diagnosing large vessel vasculitis. Q J Nucl Med Mol Imaging. 53(1):51-63, 2009
                      19. Hautzel H et al: Assessment of large-vessel involvement in giant cell arteritis with 18F-FDG PET: introducing an ROC-analysis-based cutoff ratio. J Nucl Med. 49(7):1107-13, 2008
                      20. Henes JC et al: [18F.] FDG-PET/CT as a new and sensitive imaging method for the diagnosis of large vessel vasculitis. Clin Exp Rheumatol. 26(3 Suppl 49):S47-52, 2008
                      21. Tatò F et al: Giant cell arteritis: a systemic vascular disease. Vasc Med. 13(2):127-40, 2008
                      22. Walter MA: [(18)F.] Radiol Clin North Am. 45(4):735-44, viii, 2007
                      23. Walter MA et al: The value of [18F]FDG-PET in the diagnosis of large-vessel vasculitis and the assessment of activity and extent of disease. Eur J Nucl Med Mol Imaging. 32(6):674-81, 2005
                      24. Andrews J et al: Non-invasive imaging in the diagnosis and management of Takayasu's arteritis. Ann Rheum Dis. 63(8):995-1000, 2004
                      25. Weyand CM et al: Medium- and large-vessel vasculitis. N Engl J Med. 349(2):160-9, 2003
                      26. Hutson TE et al: Temporal concurrence of vasculitis and cancer: a report of 12 cases. Arthritis Care Res. 13(6):417-23, 2000
                      Related Anatomy
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                      Related Differential Diagnoses
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                      References
                      Tables

                      Tables

                      KEY FACTS

                      • Imaging

                        • Top Differential Diagnoses

                          • Clinical Issues

                            TERMINOLOGY

                            • Definitions

                              • Large vessel vasculitis: Autoimmune-mediated inflammation of aorta and major branch vessels; leukocytes invade and damage vessel walls; bleeding, loss of vessel integrity leads to morbidity
                                • Giant cell arteritis
                                  • a.k.a. temporal arteritis, as it often affects carotid artery branches (including superficial temporal artery)
                                  • Seen in patients > 50 years old
                                • Takayasu arteritis
                                  • Often localized to portions of aorta/branch vessels
                                  • Seen in patients < 30 years old
                                • Others: Idiopathic isolated aortitis, those associated with systemic vasculitis syndromes

                            IMAGING

                            • F-18 FDG PET/CT Findings

                              DIFFERENTIAL DIAGNOSIS

                                PATHOLOGY

                                • General Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          Selected References

                                          1. de Boysson H et al: 18F-fluorodeoxyglucose positron emission tomography and the risk of subsequent aortic complications in giant-cell arteritis: a multicenter cohort of 130 patients. Medicine (Baltimore). 95(26):e3851, 2016
                                          2. Muratore F et al: Imaging of vasculitis: state of the art. Best Pract Res Clin Rheumatol. 30(4):688-706, 2016
                                          3. Alibaz-Oner F et al: Advances in the diagnosis, assessment and outcome of Takayasu's arteritis. Clin Rheumatol. 32(5):541-6, 2013
                                          4. Cohen Tervaert JW: What to do when you suspect your patient suffers from pulmonary vasculitis? Expert Opin Med Diagn. 7(1):1-4, 2013
                                          5. Martínez-Rodríguez I et al: Comparison of early (60 min) and delayed (180 min) acquisition of 18F-FDG PET/CT in large vessel vasculitis. Rev Esp Med Nucl Imagen Mol. 32(4):222-6, 2013
                                          6. Pacheco Castellanos Mdel C et al: Early diagnosis of large vessel vasculitis: usefulness of positron emission tomography with computed tomography. Reumatol Clin. 9(1):65-8, 2013
                                          7. Fuchs M et al: The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging. 39(2):344-53, 2012
                                          8. Papathanasiou ND et al: 18F-Fludeoxyglucose PET/CT in the evaluation of large-vessel vasculitis: diagnostic performance and correlation with clinical and laboratory parameters. Br J Radiol. 85(1014):e188-94, 2012
                                          9. Blockmans D: PET in vasculitis. Ann N Y Acad Sci. 1228:64-70, 2011
                                          10. James OG et al: Utility of FDG PET/CT in inflammatory cardiovascular disease. Radiographics. 31(5):1271-86, 2011
                                          11. Lamare F et al: Detection and quantification of large-vessel inflammation with 11C-(R)-PK11195 PET/CT. J Nucl Med. 52(1):33-9, 2011
                                          12. Lehmann P et al: 18F-FDG PET as a diagnostic procedure in large vessel vasculitis-a controlled, blinded re-examination of routine PET scans. Clin Rheumatol. 30(1):37-42, 2011
                                          13. Treglia G et al: Usefulness of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography in patients with large-vessel vasculitis: a systematic review. Clin Rheumatol. 30(10):1265-75, 2011
                                          14. Castañer E et al: When to suspect pulmonary vasculitis: radiologic and clinical clues. Radiographics. 30(1):33-53, 2010
                                          15. Pugliese F et al: Imaging of vascular inflammation with [11C]-PK11195 and positron emission tomography/computed tomography angiography. J Am Coll Cardiol. 56(8):653-61, 2010
                                          16. Stenová E et al: FDG-PET/CT in large-vessel vasculitis: its diagnostic and follow-up role. Rheumatol Int. 30(8):1111-4, 2010
                                          17. Zerizer I et al: Role of FDG-PET and PET/CT in the diagnosis and management of vasculitis. Eur J Radiol. 73(3):504-9, 2010
                                          18. Meller J et al: FDG-PET in patients with fever of unknown origin: the importance of diagnosing large vessel vasculitis. Q J Nucl Med Mol Imaging. 53(1):51-63, 2009
                                          19. Hautzel H et al: Assessment of large-vessel involvement in giant cell arteritis with 18F-FDG PET: introducing an ROC-analysis-based cutoff ratio. J Nucl Med. 49(7):1107-13, 2008
                                          20. Henes JC et al: [18F.] FDG-PET/CT as a new and sensitive imaging method for the diagnosis of large vessel vasculitis. Clin Exp Rheumatol. 26(3 Suppl 49):S47-52, 2008
                                          21. Tatò F et al: Giant cell arteritis: a systemic vascular disease. Vasc Med. 13(2):127-40, 2008
                                          22. Walter MA: [(18)F.] Radiol Clin North Am. 45(4):735-44, viii, 2007
                                          23. Walter MA et al: The value of [18F]FDG-PET in the diagnosis of large-vessel vasculitis and the assessment of activity and extent of disease. Eur J Nucl Med Mol Imaging. 32(6):674-81, 2005
                                          24. Andrews J et al: Non-invasive imaging in the diagnosis and management of Takayasu's arteritis. Ann Rheum Dis. 63(8):995-1000, 2004
                                          25. Weyand CM et al: Medium- and large-vessel vasculitis. N Engl J Med. 349(2):160-9, 2003
                                          26. Hutson TE et al: Temporal concurrence of vasculitis and cancer: a report of 12 cases. Arthritis Care Res. 13(6):417-23, 2000