EULAR Large Vessel Vasculitis Imaging Course (EULVIC) 2025
EULAR-ov tečaj slikovne dijagnostike vaskulitisa velikih krvnih žila (EULVIC) za 2025. Godinu
Much like transversing the Austrian alps, practicing medicine, even with some solid guidelines, can be tricky. However, if you can navigate the former, you can get help with the latter, particularly with the imaging of large blood vessels in the context of large vessel vasculitis (LVV). Of course, I am referring to the European League Against Rheumatism (EULAR) officially endorsed Large Vessel Vasculitis Imaging Course, also known as EULVIC for short, which has been taking place in Innsbruck, Austria, in the alps, usually in the fall, early October, with 2025 marking its 7th iteration; the course is planned again for October 2026.1 Along with a colleague, we had the pleasure of attending EULVIC 2025, enjoying a nice trip, and learning from experts.
As mentioned, Innsbruck, located in the Eastern part of Austria, its fifth largest city, population of over 130,000 people, plays host to this course every year. 1,2 Known for its alps and skiing, including hosting various Olympic events, it is a charming city rich with history spanning from the Middle Ages, Habsburg control, to modern times, making for picturesque walks to admire both mountain views and landmark buildings, 2 which is something I certainly took advantage of during my down time. And although the city boasts accessibility, 1,2 coming from Croatia, I found my best option, considering cost, time, and comfort, was to take the train, starting in Zagreb, and transferring twice, in Villach and Salzburg, before reaching Innsbruck. It was a comfortable and scenic ride, but took 8 hours one way. Unless you are coming from Austria or a nearby area, this is likely the reality for most looking to attend the course, losing a couple of days on travel, which, to get this out of the way, would be my only major criticism of the course, its location.
The course runs over three days, usually starting at noon the first day, then running all day during the second day, and concluding with another half day. 1 The venue, AC Hotel Innsbruck, is a standard hotel, satisfying both space for the course, its lectures and workshops, and accommodation with breakfast, which is included in the price of the course at around 1200 €.1 Christian Dejaco, Director of the Department of Rheumatology of the South Tyrol Health Trust, and Associate Professor of the Medical University of Graz, is the lead organiser of the course, playing host; he is also the lead author of the EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice.1,3 With Dejaco, the course includes several experts from the field from all over Europe; many are co-authors of the aforementioned guidelines.1,3 Dividing the course into lectures, demonstrations, and workshops, plenty of theory is covered with hands on practice.1 All modalities are covered, positron emission tomography (PET), magnetic resonance imaging (MRI), computed tomography (CT), there is even a section on pathohistology, but the focus is certainly ultrasound, of the temporal and peripheral arteries, namely for giant cell arteritis, but also Takayasu arteritis.1 Even rheumatic polymyalgia (RPM) is included as a topic with a demonstration and workshop of shoulder and hip ultrasound.1
Ultrasound of these vessels, something we could learn and include in our practice, was certainly the motivation for my colleague and I to come out for this course. With a base in musculoskeletal ultrasound, and considering the difficulty in obtaining a temporal, nevermind peripheral artery ultrasound in a timely manner often times, this was a logical next step for us. There is also a clear shift worth mentioning from temporal artery biopsy (TAB) for diagnosis to imaging, ultrasound is a much more accessible, non-invasive method.3-6 This is something that we noticed in our centre ourselves in our study of large vessel vasculitis patients during from 2011 to 2021, where comparing to a study done earlier looking at patients from 2003 to 2013, it was evident the number of TABs meaningly dropped, no doubt due to the introduction of ultrasound which was not even mentioned in the earlier study.6
Considering ultrasound is recommended as a first-line imaging method for LVV, particularly giant cell arteritis (GCA), 3 it is not surprising this was extensively covered during the course, and likely the motivation for several others to attend. For those less familiar with the latest insights, besides scanning the temporal artery, it is recommended that at least the axillary artery is also scanned, but any other large artery can also be scanned if the patient has symptoms.3-5 Since temporal artery ultrasound may be the only scan done by cooperating specialties, it makes sense for rheumatologists, especially those versed in musculoskeletal ultrasound, to perform large vessel ultrasound as well, as they have more knowledge and experience in LVV, likely know how to evaluate and determine arteries to scan, and can perform shoulder and hip ultrasound (or vice versa) as well, to completely evaluate patients on the GCA-RPM spectrum.4 Most are likely familiar with the “halo” or “compression” signs, which are still valid, but newer results show that disease can be detected via intima media thickness, measuring values over known and agreed upon threshold limits; also, new fresher lesions are usually hypoechoic, older ones are iso- or hyperechoic.4-5 PET is a useful complementary method, as is MRI, especially for Takayasu arteritis, but these methods are not the most accessible, while CT continues to prove most useful for follow-up in GCA for detecting long-term damage, namely aneuryms.3
Although we are all already overwhelmed by our responsibilities to patients, interviews and physical examinations, maybe musculoskeletal ultrasound, learning large vessel ultrasound to evaluate patients with large vessel vasculitis, for diagnosis or follow-up, is a useful tool to have in the repertoire of any rheumatologist. For those in Europe or who can make the trip to Innsbruck, Austria, EULVIC certainly serves as a great base for getting started in this area.
Daniel Victor Šimac
Department of Rheumatology and Clinical Immunology, Rijeka Clinical Hospital Centre
Zavod za reumatologiju i kliničku imunologiju, Klinički bolnički centar Rijeka
REFERENCES / Literatura
1. EULVIC 2026 [Internet]. Place of publication unknown: publisher unknown; 2026 [cited 22 Mar 2026]. Available from: https://www.eulvic.eu/
2. Wikipedia contributors. Innsbruck [Internet]. Place of publication unknown: Wikipedia, The Free Encyclopedia; 2026 [cited 10 Apr 2026]. Available from: https://en.wikipedia.org/wiki/Innsbruck
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. 2024;83:741–751. DOI:10.1136/ard-2023-224543
4. Schmidt WA, Schafer VS. Diagnosing vasculitis with ultrasound: findings and pitfalls. Ther Adv Musculoskelet Dis. 2024;16:1-24. DOI: 10.1177/1759720X241251742
5. Lau KL, Chen HH, Lan JL, Chen DY. Ultrasonography of Large-Vessel Vasculitides. Journal of Medical Ultrasound. 2012;20:72-78. DOI: 10.1016/j.jmu.2012.04.004
6. Šimac DV, Keleva D, Novak S. Presentation, diagnosis and treatment of giant cell arteritis: A single centre retrospective study. Medicina Fluminensis. 2022;58(3):303-311. DOI: 10.21860/medflum2022_281004