Diagnosing vasculitis with ultrasound: findings and pitfalls

Diagnosing vasculitis with ultrasound: findings and pitfalls

Reviewer: Lara Anders | ASA SIG: Vascular

Authors: Schmidt W and Schäfer V

Why the study was performed

This study was conducted to address the increasing integration of vascular ultrasound into rheumatology for diagnosing and managing giant cell arteritis (GCA) and Takayasu arteritis (TAK). Ultrasound offers a noninvasive, rapid diagnostic tool that allows for direct visualisation of characteristic signs like the ‘halo sign’ and intima-media thickening (IMT). It supports timely treatment to prevent symptomatic complications, aligns with new European recommendations, and has been incorporated into rheumatology training. The study also emphasises its utility in detecting subclinical disease and guiding follow-ups in clinical practice.

How the study was performed

Schmidt and Schäfer performed a comprehensive review of current literature and guidelines to evaluate the role of ultrasound in diagnosing and managing large vessel vasculitis, particularly GCA and TAK. It explored the historical context, practical applications, and evolving recommendations emphasising ultrasound as a primary diagnostic tool. The review also analysed the integration of ultrasound into rheumatology training and its increasing use in clinical practice due to advancements in equipment and expertise supported by updated international guidelines.

What the study found

The study found that vascular ultrasound is highly effective for diagnosing GCA and TAK, demonstrating strong sensitivity and specificity when performed by qualified sonographers. Key ultrasound features, such as the ‘halo sign’ and IMT measurement, reliably identify vasculitis and support diagnosis. Ultrasound assessment of IMT measurement was found to be best used in monitoring disease progression and guide ongoing treatment decisions. Ultrasound proved valuable for early detection, intervention, and prevention, thus reducing hospitalisation rates, glucocorticoid doses and secondary complications. Additionally, its accessibility facilitates quicker diagnosis of polymyalgia rheumatica and helps avoid common pitfalls, such as normal findings resulting from the rapid reduction in wall thickening following glucocorticoid treatment, which has been reported to occur as early as two days after commencement of treatment. The study also emphasised ultrasound’s role in updated classification criteria and its growing integration into current and future rheumatology practice and training.

Relevance to clinical practice

The study is highly relevant to clinical practice, as it emphasises the utility of vascular ultrasound for the timely diagnosis and management of GCA and TAK. Ultrasound enables noninvasive, real-time evaluation, reducing reliance on more invasive or resource-intensive tests. Its accessibility enables prompt intervention, preventing severe complications and improving disease management. Furthermore, the integration of ultrasound into rheumatology training and alignment with updated guidelines ensures that clinicians are well-equipped to utilise this technology to enhance patient care and streamline the diagnostic process in suspected vasculitis cases.

“rapid reduction in wall thickening following glucocorticoid treatment … has been reported to occur as early as two days after commencement of treatment”