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Imaging is increasingly being used to guide clinical decision-making in patients with giant cell arteritis (GCA). While ultrasound has been rapidly adopted in fast-track clinics worldwide as an alternative to temporal artery biopsy for the diagnosis of cranial disease, whole-body PET/CT is emerging as a potential gold standard test for establishing large vessel involvement. However, many unanswered questions remain about the optimal approach to imaging in GCA. For example, it is uncertain how best to monitor disease activity, given there is frequent discordance between imaging findings and conventional disease activity measures, and imaging changes typically fail to resolve completely with treatment. This chapter addresses the current body of evidence for the use of imaging modalities in GCA across the spectrum of diagnosis, monitoring disease activity, and long-term surveillance for structural changes of aortic dilatation and aneurysm formation and provides suggestions for future research directions., Competing Interests: Declaration of competing interest Author CEO declares advisory board for AbbVie; speaking honoraria from AbbVie, Novartis, and Janssen and Roche; co-investigator on STERLING-PMR trial, funded by NIHR-NHMRC; investigator on AbbVie and Novartis clinical trials. Author MY declares advisory board for BioGen; co-investigator on STERLING-PMR trial, funded by NIHR-NHMRC; financial support from AbbVie, and UCB to attend international conferences, including the BSR and EULAR. Author DFL co-investigator on STERLING-PMR trial, funded by NIHR-NHMRC. Author AMP declares no conflict of interest. Author HIK declares speaking honoraria from AbbVie, and Roche and Jansen; co-investigator on STERLING-PMR trial, funded by NIHR-NHMRC; investigator on AbbVie, Sanofi, and Novartis clinical trials; educational support from Pfizer. Author CLH declares co-investigator on STERLING-PMR trial, funded by NIHR-NHMRC; grant support from Vifor. Author SLM declares consultancy on behalf of her institution for Roche/Chugai, Sanofi, AbbVie and AstraZeneca; investigator on clinical trials for Sanofi, GSK, and Sparrow; speaking/lecturing on behalf of her institution for Roche/Chugai, Vifor, Pfizer, UCB, and Novartis; chief investigator on STERLING-PMR trial, funded by NIHR-NHMRC; patron of the charity PMRGCAuk. No personal remuneration was received for any of the above activities. Support from Roche/Chugai to attend EULAR2019 in person and from Pfizer to attend ACR Convergence 2021 virtually. SLM is supported in part by the NIHR Leeds Biomedical Research Centre. The views expressed in this article are those of the authors and not necessarily those of the NIHR, the NIHR Leeds Biomedical Research Centre, the National Health Service, or the UK Department of Health and Social Care., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)