2025 Chinese guideline for the imaging diagnosis and evaluation of Takayasu arteritis

Journal: Advances in Rheumatology, 2025 Developer: Chinese Rheumatology Association, Rheumatological‑Immunology Committee of Primary Health‑Care Foundation of China Evidence grading: Oxford Centre for Evidence‑Based‑Medicine grading system; Delphi‑consensus method for formulating 17 formal‑recommendation‑statementsPubMed

Abstract

Background Takayasu arteritis (TAK) is a systemic large‑vessel‑vasculitis. Imaging plays a pivotal‑role in its diagnosis and longitudinal‑evaluation. However, appropriate‑modality‑selection and standardized‑image‑interpretation remain major‑clinical‑challenges and directly‑impact therapeutic‑decision‑making. This guideline aims to establish consensus‑driven standardized‑workflow for imaging‑selection and image‑report‑interpretation in TAK patientsPubMed.

Methods An expert‑working‑group defined key‑clinical‑questions. Systematic‑literature‑review covered publications up to 31 October 2023. Evidence‑quality was appraised using Oxford‑Centre‑for‑Evidence‑Based‑Medicine‑grading. Final‑recommendations were generated via multi‑round Delphi‑expert‑consensus votingPubMed.

Results Seventeen‑recommendation‑statements were released:

1. Recommendations 1‑4: overarching‑general‑principles for multimodal‑imaging‑strategy, combined‑assessment of structural‑lesion and inflammatory‑activity, balancing radiation‑risk‑vs‑diagnostic‑yield, multimodality‑complementary‑reading.
2. Recommendations 5‑14: modality‑specific‑advantages, limitations and clinical‑indication, covering colour‑Doppler‑ultrasound / contrast‑enhanced‑ultrasound (3 statements), MRA (2 statements), CTA (2 statements), ¹⁸F‑FDG‑PET/CT (2 statements), digital‑subtraction‑angiography DSA (1 statement).
3. Recommendations 15‑17: imaging‑strategy for special‑populations (paediatric‑patients, pregnancy‑period) and organ‑perfusion‑evaluation (cerebral‑renal‑coronary‑perfusion).

Conclusion This set‑of‑consensus‑recommendations standardizes‑imaging‑utilization for clinicians across diagnosis, activity‑monitoring and follow‑up of Takayasu‑arteritis, to improve real‑world‑diagnostic‑accuracy and management‑quality of TAKPubMed.

Keywords: Takayasu arteritis; large‑vessel‑vasculitis; imaging; diagnosis; disease‑activity; guideline

Core‑key‑points (condensed‑practice‑take‑aways)

1. General‑principles

• TAK‑assessment must combine vascular‑structural‑damage (stenosis, occlusion, aneurysm, dilatation) and inflammatory‑wall‑activity; single‑modality is usually insufficient.
• Always balance diagnostic‑performance, ionizing‑radiation‑exposure, contrast‑agent‑risk, accessibility and economic‑cost.

2. Ultrasound / Contrast‑enhanced‑ultrasound (CEUS)

• Colour‑Doppler‑ultrasound: first‑line screening & serial‑follow‑up for superficial‑aortic‑branch‑vessels (carotid, subclavian, axillary, femoral arteries); detects circumferential‑wall‑thickening, hypoechoic mural‑oedema, luminal‑stenosis/occlusion; no‑radiation, repeatable, low‑cost.
• CEUS further‑improves detection of mural‑hyper‑enhancement reflecting active‑inflammation.
• Limitation: poor‑visualization for deep‑thoracic/abdominal‑aorta and visceral‑branches.

3. CTA

• Excellent‑delineation of full‑aorta and branch‑vessel‑anatomy; reliable‑for detecting stenosis, occlusion, aneurysm, dissection.
• Mural‑thickening, mural‑enhancement and perivascular‑fat‑stranding suggest active‑inflammation.
• Limitation: ionizing‑radiation, iodinated‑contrast‑agent; not preferred for frequent‑serial‑follow‑up.

4. MRA / Contrast‑enhanced‑MRA

• High‑sensitivity for mural‑oedema, delayed‑mural‑enhancement for activity‑evaluation; no‑ionizing‑radiation.
• Suitable for paediatric‑patients and pregnancy‑when‑CT‑radiation‑should‑be‑avoided.
• Limitations: long‑scan‑time; contraindicated for certain‑metal‑implants; higher‑cost; susceptibility‑artefacts.

5. ¹⁸F‑FDG‑PET‑CT

• Evaluates whole‑body‑large‑vessel‑wall‑metabolic‑inflammatory‑activity; identifies occult‑extra‑aortic‑vascular‑lesions.
• Cannot precisely‑quantify‑luminal‑stenosis; combined‑anatomical‑imaging (CT/MR) is mandatory.
• Limitation: radiation‑exposure, high‑cost.

6. DSA (digital‑subtraction‑angiography)

• Historical‑gold‑standard for luminal‑morphology.
• Now not‑used‑for‑routine‑diagnosis; reserved mainly for interventional‑pre‑procedural‑evaluation before endovascular‑treatment.

7. Special‑populations

• Paediatric‑TAK: prioritise radiation‑free‑modalities: ultrasound, MRA; minimise‑CT‑and‑PET‑CT‑usage.
• Pregnancy: ultrasound and non‑contrast‑MRA are preferred; avoid‑CTA / PET‑CT unless‑life‑threatening‑condition.
• Organ‑perfusion‑assessment: when‑clinically‑indicated, select‑targeted‑imaging for cerebral, renal and coronary‑artery‑involvement.