Due to the heterogeneity of clinical manifestations, diagnosing, monitoring, and stratifying risk in large vessel vasculitis (LVV) can be challenging. As a result of technological progress, imaging plays an increasing role in the management of LVV. Ultrasound (US), 18-FDG positron emission tomography/computed tomography (PET/CT), magnetic resonance imaging (MRI), and CT have proven diagnostic value and yielded promising data for the assessment of disease activity in giant cell arteritis (GCA) and Takayasu arteritis (TAK) (1). Since the first description of the use of US in GCA in 1995 (2), numerous studies have confirmed the diagnostic value of imaging for LVV, and the latest 2023 EULAR recommendations (3) reinforce the use of imaging for diagnosis, as well as its potential role in monitoring and assessment of vascular damage. Moreover, imaging was included for the first time in the new 2022 ACR/EULAR classification criteria for GCA (4) and TAK (5). Temporal artery (TA) US carries the same weight as TA biopsy for GCA classification, and evidence of vasculitis by imaging is an absolute requirement for the application of the TAK classification criteria.
However, several unmet needs remain, such us investigating the value of imaging composite scores for diagnosing, monitoring and prognosis of LVV, the prognostic value of positive imaging in patients in clinical remission, and the optimal timing for using imaging to detect vessel wall damage. In addition, as technological advances require constant validation of new imaging applications, this field is continuing to evolve. The articles included in the current Research Topic provide new insights and potential applications of imaging in LVV management.
Recently, interest has grown in using US to quantify vascular inflammation in GCA, and several US scores have been proposed for diagnosis and monitoring (6–10). However, they require extensive validation before they can be applied in research and clinical practice (3). In the current Research Topic, Conticini et al. investigated the diagnostic accuracy of three scores [Southend halo score, halo count, and OMERACT GCA US Score (OGUS)] in 79 patients with suspected GCA. All three scores showed good sensitivity (>70%) and excellent specificity (97%). In particular, for OGUS, a threshold of 0.81 could be employed for diagnostic purposes, although this score was primarily developed for monitoring.
Schweiger et al. retrospectively investigated the incidence and predictors [including US determined intima-media thickness (IMT)] of glucocorticoid related side effects in 138 patients with GCA. Chronic kidney disease, fractures, cataracts, dementia, and hypertension were the most frequent events. In multivariable analysis, relapses during follow-up predicted diabetes, likely due to increased glucocorticoid use. However, analytical parameters of inflammation and endothelial dysfunction, including pulse-wave velocity and IMT by US were not linked with adverse events of glucocorticoids.
The diagnosis of GCA by US relies on traditional elementary lesions such us the halo sign (inflammatory concentric thickening of the arterial wall). The halo sign is normally determined on a visual basis applying the OMERACT criteria (11). However, there are ongoing efforts to establish cut-offs for the measurement of the arterial wall thickness (IMT) in different territories for diagnostic and monitoring purposes (12–15). Seitz et al. studied cut-off values and the diagnostic accuracy of IMTs of TA segments measured by US in GCA, using for the first time a dual reference standard, namely clinical diagnosis at the patient level and MRI of the head at the segmental level. Optimal US IMT cut-offs (of both walls measured together with complete compression) were 1.01 mm for the common superficial TA, 0.82 mm for the frontal branch and 0.69 mm for the parietal branch, with 79.7% sensitivity and 90.0% specificity for the diagnosis of GCA. The authors demonstrated further in a sub-analysis that sensitivity and specificity of the cut-offs were lower in high cardiovascular risk patients suggesting that cut-offs might need to be adjusted based on the individual cardiovascular risk profile.
Nielsen et al. presented the protocol for the DANIsh VASculitis cohort (DANIVAS), a national multicenter study aiming to prospectively collect clinical data and biobank material from polymyalgia rheumatica (PMR) and GCA patients. Specific objectives include the evaluation of treatment needs in GCA patients with/without LV involvement, in PMR with/without subclinical GCA, and the prognostic role of imaging for aneurysm formation.
In a groundbreaking study, Skoog et al. evaluated the role of superb microvascular imaging (SMI) to visualize neovascularization in TA and assessed its diagnostic performance alongside US in patients with suspected GCA. SMI detected neovascularization in 14 (43%) of 33 GCA patients, and this finding was associated with more widespread cranial disease and a higher halo count. While SMI did not improve sensitivity or specificity of the exam, it might serve in future as a marker to stratify GCA patients for disease severity.
In this Research Topic, two narrative reviews focusing on the role of PET/CT in the management of LVV are also presented. Collada-Carrasco et al. focused on the use of PET/CT in the diagnosis and follow-up of LVV, including a valuable comparison of the most relevant diagnostic PET/CT scales for LVV and PMR. Thibault et al. examined the value of PET/CT in the diagnosis and follow-up of GCA, including all studies on its role in predicting relapses. Moreover, Ni and Kohler reviewed recent advances in LVV imaging, highlighting the combination of imaging modalities, and newer techniques like contrast-enhanced US, shear wave elastography and ocular US.
Another interesting aspect in this Research Topic is the multicenter retrospective study of patients with vasculitis in Poland (POLVAS) presented by Milchert et al. They demonstrated an increase in GCA diagnosis from 2008 to 2019, reaching 8.38 per 100,000 in patients 50 years or older, which can in part be attributed to the introduction of fast-track diagnostic pathways in several centers.
Petzinna et al. reviewed the pathophysiological role of vascular adhesion protein-1 (VAP-1) in vascular inflammation, focusing on GCA and PMR. They highlighted VAP-1′s involvement in immune cell adhesion, migration, and its enzymatic contributions to oxidative stress and tissue damage, as well as recent imaging advances targeting VAP-1, such as [68Ga]Ga-DOTA-Siglec-9 PET/CT, offering new insights into VAP-1′s role in GCA and PMR pathogenesis.
In summary, this Research Topic provides a collection of articles offering new insights into LVV imaging, and we believe it represents a valuable contribution to a constantly evolving field of research.
Statements
Author contributions
JM-C: Writing – original draft, Writing – review & editing. PB: Writing – review & editing. EM: Writing – review & editing. WS: Writing – review & editing. CD: Writing – review & editing.
Conflict of interest
JM-C has received consultancy/speaker's fees from AbbVie, Lilly, Janssen, Novartis, Pfizer, UCB, MSD, and BMS; trial participation as principal investigator for Novartis. None of these fees were related to the present manuscript. PB has received speaker and add board fees from Janssen and AbbVie, speaker fees from Lilly and projects grants from Pfizer. EM speakers bureau: AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grünenthal, Janssen, and Sanofi; paid instructor for: Janssen, Novartis, and Roche; consultant of: AbbVie, Novartis, Pfizer, and Galapagos; Grant/research support from: AbbVie, Novartis, and Pfizer. WS has received speaker honoraria from AbbVie, Amgen, Bristol Myers Squibb, Chugai, GlaxoSmithKline, Johnson & Johnson, Medac, Novartis, Roche, and UCB; advisory board honoraria from AbbVie, Amgen, Boehringer Ingelheim, Fresenius Kabi, GlaxoSmithKline, Novartis, and Sanofi; trial participation as principal investigator for AbbVie, GlaxoSmithKline, Novartis, and Sanofi. CD has received consulting/speaker's fees from Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos, Sparrow, Boehringer, and Sanofi; grant support from AbbVie and Novartis, all unrelated to this manuscript. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
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References
1.
Bosch P Bond M Dejaco C Ponte C Mackie SL Falzon L et al . 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. (2023) 9:e003379. 10.1136/rmdopen-2023-003379
2.
Schmidt WA Kraft HE Völker L Vorpahl K Gromnica-Ihle EJ . Colour Doppler sonography to diagnose temporal arteritis. Lancet. (1995) 345:866. 10.1016/S0140-6736(95)93005-1
3.
Dejaco C Ramiro S Bond M Bosch P Ponte C Mackie SL et al . EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update. Ann Rheum Dis. (2023) 2023:ard-2023-224543. 10.1136/annrheumdis-2023-eular.7009
4.
Ponte C Grayson PC Robson JC Suppiah R Gribbons KB Judge A et al . 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Ann Rheum Dis. (2022) 81:1647–53. 10.1136/ard-2022-223480
5.
Grayson PC Ponte C Suppiah R Robson JC Gribbons KB Judge A et al . 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis. Ann Rheum Dis. (2022) 81:1654–60. 10.1136/ard-2022-223482
6.
van der Geest KSM Borg F Kayani A Paap D Gondo P Schmidt W et al . Novel ultrasonographic Halo Score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia. Ann Rheum Dis. (2020) 79:393–9. 10.1136/annrheumdis-2019-216343
7.
Dejaco C Ponte C Monti S Rozza D Scirè CA Terslev L et al . The provisional OMERACT ultrasonography score for giant cell arteritis. Ann Rheum Dis. (2022) 82:556–64. 10.1136/ard-2022-223367
8.
Molina Collada J Martínez-Barrio J Serrano-Benavente B Castrejón I Caballero Motta LR Trives Folguera L et al . Diagnostic value of ultrasound halo count and Halo Score in giant cell arteritis: a retrospective study from routine care. Ann Rheum Dis. (2020) 2020:218631. 10.1136/annrheumdis-2020-218631
9.
Nielsen BD Therkildsen P Keller KK Gormsen LC Hansen IT Hauge EM . Ultrasonography in the assessment of disease activity in cranial and large-vessel giant cell arteritis: a prospective follow-up study. Rheumatology. (2023) 2023:kead028. 10.1093/rheumatology/kead028
10.
Molina-Collada J Monjo-Henry I Fernández-Fernández E Álvaro-Gracia JM de Miguel E . The OMERACT Giant cell arteritis Ultrasonography Score: a potential predictive outcome to assess the risk of relapse during follow-up. Rheumatology. (2024) 2024:keae260. 10.1093/rheumatology/keae260
11.
Chrysidis S Duftner C Dejaco C Schäfer VS Ramiro S Carrara G et al . Definitions and reliability assessment of elementary ultrasound lesions in giant cell arteritis: a study from the OMERACT Large Vessel Vasculitis Ultrasound Working Group. RMD Open. (2018) 4:e000598. 10.1136/rmdopen-2017-000598
12.
Bosch P Dejaco C Schmidt WA Schlüter KD Pregartner G Schäfer VS . Ultrasound for diagnosis and follow-up of chronic axillary vasculitis in patients with long-standing giant cell arteritis. Ther Adv Musculoskelet Dis. (2021) 13:1759720X21998505. 10.1177/1759720X21998505
13.
Ješe R Rotar Ž Tomšič M Hočevar A . The cut-off values for the intima-media complex thickness assessed by colour Doppler sonography in seven cranial and aortic arch arteries. Rheumatology. (2021) 60:1346–52. 10.1093/rheumatology/keaa578
14.
Schäfer VS Juche A Ramiro S Krause A Schmidt WA . Ultrasound cut-off values for intima-media thickness of temporal, facial and axillary arteries in giant cell arteritis. Rheumatology. (2017) 56:1479–83. 10.1093/rheumatology/kex143
15.
López-Gloria K Castrejón I Nieto-González JC Rodríguez-Merlos P Serrano-Benavente B González CM et al . Ultrasound intima media thickness cut-off values for cranial and extracranial arteries in patients with suspected giant cell arteritis. Front Med. (2022) 9:981804. 10.3389/fmed.2022.981804
Summary
Keywords
imaging, ultrasound, MRI, PET-CT, large vessel vasculitis, giant cell arteritis, polymyalgia rheumatica, Takayasu arteritis
Citation
Molina-Collada J, Bosch P, de Miguel E, Schmidt WA and Dejaco C (2024) Editorial: New insights into the role of imaging in large vessel vasculitis. Front. Med. 11:1528452. doi: 10.3389/fmed.2024.1528452
Received
14 November 2024
Accepted
19 November 2024
Published
03 December 2024
Volume
11 - 2024
Edited and reviewed by
João Eurico Fonseca, University of Lisbon, Portugal
Updates
Copyright
© 2024 Molina-Collada, Bosch, de Miguel, Schmidt and Dejaco.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Juan Molina-Collada molinacolladajuan@gmail.com
†ORCID: Juan Molina-Collada orcid.org/0000-0001-5191-7802
Philipp Bosch orcid.org/0000-0002-6783-6422
Eugenio de Miguel orcid.org/0000-0001-5146-1964
Wolfgang A. Schmidt orcid.org/0000-0001-7831-8738
Christian Dejaco orcid.org/0000-0002-0173-0668
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.