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Aghayev A, Steigner ML, Azene EM, Burns J, Chareonthaitawee P, Desjardins B, El Khouli RH, Grayson PC, Hedgire SS, Kalva SP, Ledbetter LN, Lee YJ, Mauro DM, Pelaez A, Pillai AK, Singh N, Suranyi PS, Verma N, Williamson EE, Dill KE. ACR Appropriateness Criteria® Noncerebral Vasculitis. J Am Coll Radiol 2021; 18:S380-S393. [PMID: 34794595 DOI: 10.1016/j.jacr.2021.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 10/19/2022]
Abstract
Noncerebral vasculitis is a wide-range noninfectious inflammatory disorder affecting the vessels. Vasculitides have been categorized based on the vessel size, such as large-vessel vasculitis, medium-vessel vasculitis, and small-vessel vasculitis. In this document, we cover large-vessel vasculitis and medium-vessel vasculitis. Due to the challenges of vessel biopsy, imaging plays a crucial role in diagnosing this entity. While CTA and MRA can both provide anatomical details of the vessel wall, including wall thickness and enhancement in large-vessel vasculitis, FDG-PET/CT can show functional assessment based on the glycolytic activity of inflammatory cells in the inflamed vessels. Given the size of the vessel in medium-vessel vasculitis, invasive arteriography is still a choice for imaging. However, high-resolution CTA images can depict small-caliber aneurysms, and thus can be utilized in the diagnosis of medium-vessel vasculitis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Ayaz Aghayev
- Panel Vice-Chair, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Michael L Steigner
- Panel Chair; and Vascular CT and MR, and Medical Director 3D Lab, Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Judah Burns
- Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | | | | | - Riham H El Khouli
- Director, Theranostic Program and Chair, NM&MI Clinical Protocol and Quality Improvement (CPQI) Committee, University of Kentucky, Lexington, Kentucky
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, Rheumatologist
| | - Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sanjeeva P Kalva
- Chief, Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts; International Editor, Journal of Clinical Interventional Radiology ISVIR; and Assistant Editor, Radiology - Cardiothoracic, RSNA
| | - Luke N Ledbetter
- Director, Head and Neck Imaging, University of California Los Angeles, Los Angeles, California
| | - Yoo Jin Lee
- University of California San Francisco, San Francisco, California
| | - David M Mauro
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Andres Pelaez
- Director, Lung Transplant Program, University of Florida Gainesville, Gainesville, Florida; and Primary care physician
| | - Anil K Pillai
- Section Chief, UT Southwestern Medical Center, Dallas, Texas
| | | | - Pal S Suranyi
- Medical University of South Carolina, Charleston, South Carolina
| | - Nupur Verma
- Program Director, Department of Radiology, University of Florida, Gainesville, Florida
| | - Eric E Williamson
- Mayo Clinic, Rochester, New York, Society of Cardiovascular Computed Tomography
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
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