Ultrasound in Vasculitis



While musculoskeletal ultrasound is growing and widely accepted as part of a rheumatologist’s daily clinical practice, there has also been high interest in the potential use of ultrasound for diagnosis and treatment follow-up of patients with large vessel vasculitis. This chapter reviews the current evidence regarding ultrasound in vasculitis, an introduction to basic vascular ultrasound settings, and a standardized scanning protocol to consider for these patients.


Vasculitis Ultrasound Ultrasonography Large-vessel vasculitides Giant cell arteritis 


  1. 1.
    Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Grayson PC, Maksimowicz-McKinnon K, Clark TM, Tomasson G, Cuthbertson D, Carette S, et al. Distribution of arterial lesions in Takayasu's arteritis and giant cell arteritis. Ann Rheum Dis. 2012;71(8):1329–34.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Aschwanden M, Kesten F, Stern M, Thalhammer C, Walker UA, Tyndall A, et al. Vascular involvement in patients with giant cell arteritis determined by duplex sonography of 2x11 arterial regions. Ann Rheum Dis. 2010;69(7):1356–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Kang T, Lanni S, Nam J, Emery P, Wakefield RJ. The evolution of ultrasound in rheumatology. Therapeutic Adv Musculoskelet Disease. 2012;4(6):399–411.Google Scholar
  5. 5.
    Salvarani C, Silingardi M, Ghirarduzzi A, Lo Scocco G, Macchioni P, Bajocchi G, et al. Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis? Ann Intern Med. 2002;137(4):232–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Menkes CJ, Branche I, Feldmann JL, Chauveau M, Delbarre F. Application of the Doppler effect to the detection of Horton’s temporal arteritis. La Nouvelle presse medicale. 1981;10(28):2371.PubMedGoogle Scholar
  7. 7.
    Schmidt WA, Kraft HE, Vorpahl K, Volker L, Gromnica-Ihle EJ. Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med. 1997;337(19):1336–42.CrossRefPubMedGoogle Scholar
  8. 8.
    Diamantopoulos AP, Haugeberg G, Hetland H, Soldal DM, Bie R, Myklebust G. The diagnostic value of color Doppler ultrasonography of temporal arteries and large vessels in giant cell arteritis: a consecutive case series. Arthritis Care Res. 2013.Google Scholar
  9. 9.
    Jennifer Piper ASS, Cristina Ponte, Surjeet Singh, Bhaskar Dasgupta, Wolfgang A Schmidt, Eugene McNally, Andreas Diamantopoulos, Andrew Hutchings, Raashid Luqmani. A diagnostic protocol for giant cell arteritis using ultrasound assessment. Rheumatology 2015;54(suppl 1):i33–i.Google Scholar
  10. 10.
    Arida A, Kyprianou M, Kanakis M, Sfikakis PP. The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskelet Disord. 2010;11:44.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Karassa FB, Matsagas MI, Schmidt WA, Ioannidis JP. Meta-analysis: test performance of ultrasonography for giant-cell arteritis. Ann Intern Med. 2005;142(5):359–69.CrossRefPubMedGoogle Scholar
  12. 12.
    Ball EL, Walsh SR, Tang TY, Gohil R, Clarke JM. Role of ultrasonography in the diagnosis of temporal arteritis. Br J Surg. 2010;97(12):1765–71.CrossRefPubMedGoogle Scholar
  13. 13.
    Schmidt WA, Natusch A, Moller DE, Vorpahl K, Gromnica-Ihle E. Involvement of peripheral arteries in giant cell arteritis: a color Doppler sonography study. Clin Exp Rheumatol. 2002;20(3):309–18.PubMedGoogle Scholar
  14. 14.
    Pfadenhauer K, Weber H. Giant cell arteritis of the occipital arteries––a prospective color coded duplex sonography study in 78 patients. J Neurol. 2003;250(7):844–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Germano G, Muratore F, Cimino L, Lo Gullo A, Possemato N, Macchioni P, et al. Is colour duplex sonographyguided temporal artery biopsy useful in the diagnosis of giant cell arteritis? A randomized study. Rheumatology (Oxford), 2014.Google Scholar
  16. 16.
    Ghinoi A, Pipitone N, Nicolini A, Boiardi L, Silingardi M, Germano G, et al. Large-vessel involvement in recentonset giant cell arteritis: a case-control colour-Doppler sonography study. Rheumatology (Oxford), 2011.Google Scholar
  17. 17.
    Czihal M, Tato F, Forster S, Rademacher A, Schulze-Koops H, Hoffmann U. Fever of unknown origin as initial manifestation of large vessel giant cell arteritis: diagnosis by colour-coded sonography and 18-FDG-PET. Clin Exp Rheumatol. 2010;28(4):549–52.PubMedGoogle Scholar
  18. 18.
    Forster S, Tato F, Weiss M, Czihal M, Rominger A, Bartenstein P, et al. Patterns of extracranial involvement in newly diagnosed giant cell arteritis assessed by physical examination, colour coded duplex sonography and FDG-PET. Vasa. 2011;40(3):219–27.CrossRefPubMedGoogle Scholar
  19. 19.
    Czihal M, Tato F, Rademacher A, Kuhlencordt P, Schulze-Koops H, Hoffmann U. Involvement of the femoropopliteal arteries in giant cell arteritis: clinical and color duplex sonography. J Rheumatol. 2012;39(2):314–21.CrossRefPubMedGoogle Scholar
  20. 20.
    Czihal M, Zanker S, Rademacher A, Tato F, Kuhlencordt PJ, Schulze-Koops H, et al. Sonographic and clinical pattern of extracranial and cranial giant cell arteritis. Scand J Rheumatol. 2012;41(3):231–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Blockmans D, Bley T, Schmidt W. Imaging for large-vessel vasculitis. Curr Opin Rheumatol. 2009;21(1):19–28.CrossRefPubMedGoogle Scholar
  22. 22.
    Schmidt WA, Krause A, Schicke B, Wernicke D. Color Doppler ultrasonography of hand and finger arteries to differentiate primary from secondary forms of Raynaud's phenomenon. J Rheumatol. 2008;35(8):1591–8.PubMedGoogle Scholar
  23. 23.
    Diamantopoulos AP, Haugeberg G, Hetland H, Soldal DM, Myklebust G. “Fast track” giant cell arteritis outpatient clinic: a useful tool to reduce the morbidity of the disease? EULAR Madrid 2013.Google Scholar
  24. 24.
    Schmidt WA. Role of ultrasound in the understanding and management of vasculitis. Therapeut Adv Musculoskeletal Dis. 2014;6(2):39–47.CrossRefGoogle Scholar
  25. 25.
    Bley TA, Reinhard M, Hauenstein C, Markl M, Warnatz K, Hetzel A, et al. Comparison of duplex sonography and high-resolution magnetic resonance imaging in the diagnosis of giant cell (temporal) arteritis. Arthritis Rheum. 2008;58(8):2574–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Schmidt WA. Imaging in vasculitis. Best Pract Res Clin Rheumatol. 2013;27(1):107–18.CrossRefPubMedGoogle Scholar
  27. 27.
    Pipitone N, Versari A, Salvarani C. Role of imaging studies in the diagnosis and follow-up of large-vessel vasculitis: an update. Rheumatology (Oxford). 2008;47(4):403–8.CrossRefGoogle Scholar
  28. 28.
    HelseNorge. MR-undersøkelse (magnetisk resonans). Available from:
  29. 29.
    Prieto-Gonzalez S, Arguis P, Garcia-Martinez A, Espigol-Frigole G, Tavera-Bahillo I, Butjosa M, et al. Large vessel involvement in biopsy-proven giant cell arteritis: prospective study in 40 newly diagnosed patients using CT angiography. Ann Rheum Dis. 2012;71(7):1170–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Kissin EY, Merkel PA. Diagnostic imaging in Takayasu arteritis. Curr Opin Rheumatol. 2004;16(1):31–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Wu TH, Kuo HC, Tain YL, et al. Common carotid artery intima-media thickness is useful for diagnosis of the acute stage of Kawasaki disease. BMC Pediatrics. 2014;14:98.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Baer AZ, Rubin LG, Shapiro CA, et al. Prevalence of coronary artery lesions on the initial echocardiogram in Kawasaki syndrome. Arch Pediatr Adolesc Med. 2006;160(7):686–90.CrossRefPubMedGoogle Scholar
  33. 33.
    Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012;64(4):943–54.CrossRefPubMedGoogle Scholar
  34. 34.
    Schmidt WA, Gromnica-Ihle E. Incidence of temporal arteritis in patients with polymyalgia rheumatica: a prospective study using colour Doppler ultrasonography of the temporal arteries. Rheumatology (Oxford). 2002;41(1):46–52.CrossRefPubMedGoogle Scholar
  35. 35.
    Schmidt WA, Seifert A, Gromnica-Ihle E, et al. Ultrasound of proximal upper extremity arteries to increase the diagnostic yield in large-vessel giant cell arteritis. Rheumatology (Oxford). 2008;47(1):96–101.CrossRefGoogle Scholar
  36. 36.
    Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34(4):290–6.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Schmidt WA. Ultrasound in vasculitis. Clin Exp Rheumatol. 2014;32(1 Suppl 80):S71–7.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of RheumatologyHospital for Rheumatic Diseases in HaugesundHaugesundNorway
  2. 2.Department of RheumatologyHospital of Southern Norway TrustKristiansandNorway

Personalised recommendations