Takayasu arteritis: diagnosis with MR imaging and MR angiography in acute and chronic active stages.

Early diagnosis and treatment of Takayasu arteritis is important in prevention of serious complications. Spin-echo magnetic resonance imaging (MRI) can depict early wall thickening of the aorta and cine MRI can evaluate aortic valve function. Significant enhancement in and around the aorta and carotid arteries is observed on postcontrast MR images in acute phase Takayasu arteritis. In the chronic phase, contrast enhancement in the aortic wall stronger than in the myocardium suggests activity of the disease. Breath-hold contrast-enhanced three-dimensional MR angiography is very effective in noninvasive evaluation of luminal change of aortitis. Contrast-enhanced MRI and MR angiography have an important role in early diagnosis, activity determination, and follow-up of Takayasu arteritis. MRI and MR angiography can be utilized for initial diagnosis of Takayasu arteritis and replace catheterization angiography. J. Magn. Reson. Imaging 1999;10:751-757.     

Role of magnetic resonance imaging in the early diagnosis of Takayasu arteritis

Takayasu arteritis is a non-specific inflammatory process of unknown aetiology affecting the aorta and its major branches. It may lead to stenosis or occlusion. We have examined eight patients with clinically diagnosed Takayasu arteritis using contrast-enhanced MRI and also 3-D MR angiography. All patients were female and their ages varied between 22 and 48 years. We were able to show subtle arteritic changes and stenotic lesions in branch vessels in the early phase of the disease by using this imaging modality. Thus, we can state that contrast-enhanced MRI with 3-D MR angiography can be used for the initial diagnosis of Takayasu arteritis. It provides a means to evaluate the vascular tree non-invasively and may replace conventional angiography.     

FDG-PET finding in early-phase Takayasu arteritis

We report a unique case of early-phase Takayasu arteritis in which the vessels demonstrated accumulation of [18F]fluorodeoxyglucose (FDG) on PET scanning. This observation suggests the possible use of FDG-PET for the diagnosis of vasculitis. Early diagnosis of Takayasu arteritis may permit early treatment and possibly could prevent progression to the occlusive or pulseless phase of this disease.     

Follow-up electron beam CT for the management of early phase Takayasu arteritis.

PURPOSE: The purpose of this work was to assess typical findings of Takayasu arteritis on serial CT examinations following therapy. METHOD: Serial CT studies were performed on 16 patients with early phase Takayasu arteritis. Mural or luminal changes of the aorta on successive CT scans were compared with clinical data. RESULTS: Vascular lesions progressed during follow-up in 6 of 16 patients. In one patient, progression of lesions was symptomatic. In the other five of six patients with worsening lesions, vascular progression occurred without new clinical symptoms and was first identified on CT scans. One of these five had dilatation of the ascending aorta and required aortic repair. Four others had progression of stenotic vascular lesions leading to changes in medical treatment only or in combination with either surgery or angioplasty. For two of them, CT examinations showed decreased mural lesions after changes in medical treatment. CONCLUSION: CT examinations performed in treated patients with Takayasu arteritis demonstrate either regression, stabilization, or progression of vascular lesions. Serial CT examinations may thus be useful for evaluating response to treatment.     

Takayasu arteritis: diagnosis with breath-hold contrast-enhanced three-dimensional MR angiography

The purpose of the study was to determine the diagnostic accuracy of breath-hold contrast-enhanced three-dimensional (3D) magnetic resonance (MR) angiography in Takayasu arteritis. Thirty patients suspected of having Takayasu arteritis were examined with MR angiography and conventional angiography. Takayasu arteritis was diagnosed in 20 of these patients. MR angiography was performed using a 1.5-T system after bolus injection of 0.1 mmol/kg of gadodiamide. MR angiography clearly depicted various vascular lesions in the aorta and its major branches in all 20 patients with Takayasu arteritis. It also depicted pulmonary artery lesions in 10 (50%) of the 20 patients. MR angiography accurately depicted 323 (98%) of 330 arteries, but 7 (2%) stenotic arteries were overestimated as occluded. The sensitivity and specificity of MR angiography for the diagnosis of Takayasu arteritis were both 100%. Breath-hold contrast-enhanced 3D MR angiography clearly depicts various vascular lesions in both the systemic and pulmonary arteries in Takayasu arteritis, thus allowing a definitive diagnosis of Takayasu arteritis.     

Three‐dimensional velocity mapping of thoracic aorta and supra‐aortic arteries in takayasu arteritis

Takayasu arteritis is an inflammatory disease of unknown etiology that involves the aorta, its major branches, and the pulmonary artery. We describe three patients with Takayasu arteritis who showed abnormal velocity profile of the thoracic aorta and supra‐aortic arteries on time‐resolved three‐dimensional (3D) phase‐contrast MR imaging and velocity mapping techniques. Compared with two comparative subjects, velocity reduction was observed in these arteries. The velocity reduction was prominent along the thickened arterial wall, even with normal luminal caliber, and the highest velocity was observed on the contralateral side. In one patient, the arterial flow velocity and its profile at systole were partly improved after the treatment. The time‐resolved 3D velocity mapping visualized the changes in the blood velocity profile at systole in Takayasu arteritis. J. Magn. Reson. Imaging 2010;31:1481–1485. ©2010 Wiley‐Liss, Inc.     

Takayasu arteritis: imaging spectrum at multidetector CT angiography

Takayasu arteritis is a chronic, idiopathic, inflammatory disease that primarily affects large vessels, such as the aorta and its major branches and the pulmonary and coronary arteries. The non-specific inflammation of involved vessels usually leads to concentric wall thickening, fibrosis and thrombus formation. Diseased arteries become stenotic or occluded, undergo vascular remodelling or develop aneurysms. According to the involvement of arteries, six types of Takayasu arteritis are documented. The purpose of this pictorial review is to illustrate the various multidetector CT angiography appearances of Takayasu arteritis and to discuss the differential diagnosis.Takayasu arteritis (TA) is a chronic, idiopathic, inflammatory disease that primarily affects large vessels, such as the aorta and its major branches, pulmonary and coronary arteries. Because of considerable morbidity and mortality, accurate and early diagnosis plays a crucial role in improving the outcomes for patients with TA [1]. Unfortunately, the non-specific clinical presentations and laboratory test results frequently contribute to late diagnosis and delayed treatment [1]. Since large-artery biopsies cannot easily be done, imaging examination is essential for providing the diagnosis and differential diagnoses in patients with suspected TA.Conventional angiography has been traditionally considered the gold standard for the diagnosis of TA [2]. However, multidetector CT angiography (CTA) is emerging as a reliable tool in non-invasively depicting both luminal and mural lesions in the aorta and its main branches, which may facilitate the detection of vasculitis during the early phase of TA.In this article, we will review the CTA findings in TA and how this non-invasive method impacts patient care.     

大动脉炎血管壁的磁共振表现特点

目的：分析大动脉炎血管壁的MR表现特征及其临床应用价值。方法：32例临床确诊为大动脉炎的患者接受了MR检查,其中处于病情活动期20例,非活动期12例。分析并比较了两组患者受累动脉管壁的MR表现特征。结果：所有受累动脉的血管壁均不同程度的环形增厚。活动期组患者的管壁厚度较非活动期组患者明显增厚[（4．6±0．4）mm vs（3．4±0．6）mm,P〈0．01];比较两组增厚的血管壁形态,管壁呈“多环征”（分别为89／100和25／60）、内层明显强化（分别为66／100和24／60）、血管外界模糊不清（分别为72／100和20／60）等征象,经Х^2检验差异均有统计学意义（P〈0．01）。结论：大动脉炎血管壁的MR主要征象是管壁增厚及其信号改变。MRI能观察血管壁精细的形态学变化,对大动脉炎管腔狭窄前的早期诊断以及活动性判断具有重要价值。     

3.0 T高分辨率MR血管壁成像对大动脉炎活动性判断的价值

目的 探讨3.0 T高分辨率MR血管壁成像对大动脉炎活动性判断的价值.方法 26例确诊为大动脉炎的患者(根据Lupi-Herrea分类,为Ⅰ和Ⅲ型,均累及主动脉弓及其主要大分支)接受了颈部及上胸部MR血管壁成像,其中处于病情活动期16例,非活动期10例.分析并比较了2组患者受累动脉管壁的MRI表现特征.采用X~2检验对2组患者的血管壁形态进行统计学分析.结果 所有受累动脉的血管壁均有不同程度的环形增厚.活动期组患者的管壁厚度较非活动期组患者增厚明显[分别为(3.8±0.2)和(2.5±0.8) mm];比较2组增厚的血管壁形态,管壁呈多环征(分别为75/80和18/50)、内壁明显强化(分别为50/80和19/50)、血管外界模糊不清(分别为55/80和18/50)等征象,差异均有统计学意义(X~2值分别为50.39、7.41、13.40,P值均<0.01).结论 大动脉炎高分辨率MR血管壁成像的主要征象是管壁增厚及信号改变,3.0 T MR血管壁成像能精细观察血管壁的形态学变化,对大动脉炎的活动性判断具有重要价值.     

The value of total aortography in the diagnosis of Takayasu's arteritis.

The arteriographic and clinical spectrum of Takayasu's arteritis in a series of 23 cases is reviewed. The incidence of the disease appears to be much higher than is generally suspected. Although it primarily afflicts young women, children are frequently affected. Two clinical stages of the disease are recognized: an early systemic and a late occlusive phase. The signs and symptoms of both stages are protean and variable. The pathological appearance varies with the activity and duration of the disease. Total aortography is of primary diagnostic importance in demonstrating the characteristic appearance of the diseased aorta.     

18F-FDG PET/CT in the diagnosis of Takayasu arteritis: A case report

The early clinical symptoms of Takayasu arteritis (TAK) are nonspecific and often lead to misdiagnosis or delay in diagnosis. And by the time morphological changes are observed on the images, the disease is in an advanced stage and irreversible vascular injuries has occurred. Therefore, early correct diagnosis and timely systemic anti-inflammatory treatment can effectively improve the clinical situation. Conventional imaging provides only changes in vascular structure and provides little information on inflammatory activity. Here we report the PET/CT imaging presentation of 18F-deoxyglucose (¹⁸F-FDG) in a patient with TAK, a 58-year-old patient with known TAK whose disease clustered many non-specific features, and highlight the value of PET/CT in the diagnosis and management of patients with early or atypical clinical presentation of TAK.Keyword: TAK, PET/CT, Diagnosis     

Multiple cerebral aneurysms associated with Takayasu arteritis successfully treated with coil embolization

The cerebrovascular complications of Takayasu arteritis are primarily related to the presence of occlusive lesions. Cerebral aneurysms rarely occur as complications; only 18 cases have been reported thus far. The use of coil embolization to treat cerebral aneurysms occurring as a complication of Takayasu arteritis has not been previously reported. We report a case of Takayasu arteritis with a basilar tip aneurysm and a P1 segment aneurysm of the left posterior cerebral artery that were successfully treated with coil embolization. Because coil embolization for cerebral aneurysms associated with Takayasu arteritis requires the use of limited access routes that have extremely curved and tortuous courses, catheter navigation was difficult. The guide catheter, microcatheter, and guidewire must be selected and navigated with greater care than is usually required for common aneurysm embolization.     

Imaging Characteristics of Takayasu Arteritis

Takayasu arteritis is a rare, large-vessel vasculitis in which the nonspecific systemic inflammatory symptoms are followed by inflammation of the aorta and its major branches. The inflammation of this vessel leads to progressive luminal stenosis or aneurysm formation resulting in limb or organ ischemia. Although conventional angiography is still accepted as the gold standard modality, the information obtained is limited to the vessel lumen. Multidetector computed tomographic angiography and magnetic resonance angiography can provide valuable information not only regarding intraluminal pathologies but also concerning the thickening of the vessel wall, which may be the earliest manifestation of the disease.     

Takayasu arteritis: radiographic and angiographic findings in 59 patients

Fifty-nine patients (57 females, two males) with Takayasu arteritis were retrospectively evaluated. Chest radiographs were abnormal in 68% of patients in whom they were obtained (n = 49). Aortic contour changes and calcification were frequent findings. Sixty-eight percent of patients who underwent total aortography (n = 50) had panaortitis, and 28% had involvement confined to the thoracic aorta and/or its branches. Stenosis was the most common angiographic finding in the aorta and its branches, but occlusion (n = 4), aneurysm (n = 3), and dilatation (n = 15) were not infrequent. Adventitial vascular structures (the vasa vasorum) were seen in three cases. Eighty-six percent (n = 21) of pulmonary arteriograms showed abnormalities. Occlusion was by far the most common finding. There was no predilection for any lobe nor correlation with systemic arteritis. It was concluded that Takayasu arteritis characteristically involves the systemic and the pulmonary arteries independently. Total aortography and pulmonary arteriography are necessary to diagnose and evaluate the extent of the disease.     

Percutaneous Management of Occlusive Arterial Disease Associated with Vasculitis: A Single Center Experience

The purpose of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty for occlusive arterial disease associated with vasculitis. Eleven patients (10 women, 1 man; ages 35–82 years) with the diagnosis of vasculitis of the large vessels underwent interventional treatment during intraarterial angiography. The causes included giant cell arteritis (n = 8) and Takayasu arteritis (n = 3). Thirty-three occlusive lesions (including brachiocephalic and renal arteries, and arteries of upper and lower extremities) were treated with balloon angioplasty and/or stent placement. Follow-up included clinical examination, angiography, and color duplex ultrasound. Technical success was 100% (25/25) for stenoses and 50% (4/8) for occlusive lesions, representing all lesions combined from different anatomic locations. Dissection (n = 3) and arterial rupture with retroperitoneal hematoma (n = 1) was found in three patients. During follow-up (mean 12 months), restenoses (n = 8) and re-restenoses (n = 1) occurred in 8 vascular areas. Three of these lesions were treated with repeated PTA (n = 4). The cumulative primary clinical success rate was 67.6%, cumulative secondary success rate 74.4%, and cumulative tertiary success rate 75.9%. Interventional therapy in systemic vasculitis provides promising results in technical success rates and followup. Angioplasty may result in arterial injury, but the rate of complications is low.     

32接收通道并行采集全身MR血管成像技术的临床应用初探

目的初步探讨32接收通道并行采集全身MR血管成像技术在系统性动脉病变中的临床使用价值。方法30例接受三维增强全身MR血管成像(3D CE MRA)检查。仪器为1.5 T成像仪(M agnetom Avanto,S iem ens AG)配置32个接收通道和并行采集技术。病例包括临床诊断或怀疑的周围动脉闭塞性病变(PAOD)17例,多发性大动脉炎3例,结节性多动脉炎1例,Stanford B型夹层4例以及胸和(或)腹主动脉瘤5例。共使用68个表面线圈单元包绕患者全身。3D CE MRA共分4段采集,每段视野(FOV)为375 mm×500 mm,通过自动移床分段扫描,第1~3段使用并行采集技术。对比剂用量为0.3 mmol/kg,分两相注射,前0.15 mmol/kg注射流率为1.3 m l/s,后0.15 mmol/kg注射流率为0.6 m l/s。总的扫描长度约188 cm,覆盖颈动脉到小腿动脉分支(不包括颅内动脉和冠状动脉)。分析每段动脉的图像质量、各种动脉血管病变的显示效果,并同其他影像检查对照(包括DSA 9例,CT血管造影8例,单段MRA 1例)。结果所有病例均顺利完成全身3D CE MRA检查。动脉图像质量好,平均检查时间为17.4 m in。17例PAOD患者中发现70段下肢动脉病变,其中7例3D CE MRA显示了除下肢动脉病变以外的其他部位动脉狭窄。4例血管炎患者3D CE MRA显示全身多处动脉管腔不规则、狭窄或闭塞、动脉瘤以及侧支血管。3D CE MRA还清楚显示夹层和动脉瘤的严重程度和范围。与其他血管成像技术比较,除1例3D CE MRA高估血管狭窄程度外,其他均相符合。结论配置了32个接收通道和并行采集技术的新型MR成像仪能顺利完成全身3D CE MRA检查,该法操作简便,检查时间短,在全面显示各种系统性动脉病变的临床使用方面有重要价值。     

大动脉炎的多层螺旋CT诊断

目的 :探讨大动脉炎的多层螺旋CT表现。方法 :回顾性分析 7例大动脉炎患者的CT表现 ,所有病例均经临床及多层螺旋CT血管成像 (MSCTA)确诊。结果 :7例大动脉炎患者多层螺旋CT血管成像主要表现为主动脉及其分支血管管腔的狭窄、闭塞、扩张及血管壁增厚与钙化。结论 :多层螺旋CT血管成像能准确诊断大动脉炎患者主动脉及其主要分支的管腔与管壁的变化。     

Initial pulmonary artery involvement in Takayasu arteritis

Although the pulmonary artery is involved in many cases of Takayasu arteritis, few cases have been reported in which the pulmonary artery was initially involved. Two such cases are reported here. Both of these cases had been initially diagnosed as chronic pulmonary embolism. The importance of considering Takayasu arteritis in cases of chronic pulmonary arterial obstruction of unknown cause is emphasized. Bronchial-pulmonary artery communication and coronary-bronchial artery communication in Takayasu arteritis are also discussed.     

Pulmonary vasculitis: the spectrum of radiological findings

Pulmonary vasculitis includes various disease entities with a wide range of clinical presentations and overlapping imaging features. Radiological findings of vasculitis in the angiitis-granulomatosis group are nodular and patchy opacities, whereas the principal feature of those diseases causing widespread capillaritis is diffuse air space consolidation. Aneurysms or stenoses of pulmonary arteries are seen in patients with Takayasu arteritis or Beh?et's disease.     

Spectrum of imaging findings in Takayasu arteritis—A case report

Takayasu arteritis (TA) is an uncommon chronic granulomatous inflammatory disease often affecting the aorta and its branches. Early diagnosis is quite challenging due to nonspecific symptoms and unfamiliarity with the disease. We hereby present a case of a young female patient diagnosed with Type V Takayasu arteritis using several radiological imaging modalities such as color and spectral Doppler study and computed tomography angiography. A timely diagnosis of Takayasu arteritis however may improve the outcome such as irreversible target organ damage and poor prognosis with a decreased rate of complications.