Imaging is increasingly recognised as an essential element in the management of several rheumatologic conditions. Ultrasound is in widespread use as a safe, reproducible, and directly interpretable method for diagnosis and evaluation of arthritis and increasingly of large-vessel vasculitis (LVV). Indeed, the diagnosis and management of LVV are being transformed through the use of imaging. Increasing and more standardised evidence is being produced on the role of colour duplex sonography in the management of LVV. Nonetheless, some controversies and unresolved issues remain. This review describes current findings and reviews future perspectives in the use of ultrasound for the diagnosis and management of LVV.