Follow-up CT Evaluation of the Mural Changes in Active Takayasu Arteritis

Objective

We wanted to evaluate the mural changes by CT on the follow-up examination of patients with active Takayasu arteritis.

Materials and Methods

The study included 18 patients, (4 males and 14 females), with active Takayasu arteritis. A total of 44 CT examinations were done during the follow-up period (mean: 55.6 months). At the time of the last follow-up CT, the disease, on the basis of the erythrocyte sedimentation rate (ESR), was found to be inactive in five patients and the disease was active and persistent in 13 patients. The thickness and CT attenuation of the aortic wall on the precontrast, arterial and venous phases were measured on the initial and the follow-up CT examinations. The ratio of the mural attenuation over that of the back muscle on the initial CT was compared with the ratio found on the follow-up CT.

Results

The initial CT findings included high density and calcifications of the aortic wall in the precontrast images and a thickened wall with enhancements in the arterial and the venous phases. A low-attenuation ring was demonstrated in the venous phase in 15 patients (83%). On the follow-up evaluation, the mean mural thickness decreased significantly from 4.1 mm to 2.4 mm. The mean mural attenuation ratio in the venous phase decreased significantly from 1.9 to 1.3 (p = 0.001). The low attenuation ring was identified in seven patients (39%) who had only with active, persistent Takayasu arteritis.

Conclusion

The mural changes demonstrated by the follow-up CT evaluations for the patients with active Takayasu arteritis included a decrease of the mural thickness and enhancement, disappearance of the low-attenuation ring on the venous phase, and an increase of the mural attenuation and calcification on the precontrast phase.     

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.     

Computed Tomographic Findings of Syphilitic Aortitis: A Case Report

We describe the computerized tomographic (CT) findings of the aortic wall in a case of acute-phase syphilitic arteritis. The delayed phase of the contrast-enhanced CT shows a double-ring configuration of the thick thoracic aortic wall, which is similar to CT findings previously reported for Takayasu arteritis. We speculate that the resemblance of the CT findings for these two diseases accounts for their similar histopathological features.     

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.     

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。     

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.     

Abnormal accumulation of [18F]fluorodeoxyglucose in the aortic wall related to inflammatory changes: Three case reports

We present 3 cases with abnormal accumulation of FDG in the aortic wall. Their clinical manifestations were vague or asymptomatic, and laboratory data were consistent with inflammatory reaction. These 3 patients were diagnosed with Takayasu arteritis, inflammatory aortic aneurysm (IAA), and retroperitoneal fibrosis (RF), respectively. FDG-PET and CT images showed the intense FDG uptake corresponding to the arterial walls and/or the soft tissue density surrounding the artery. It was deduced that FDG was probably taken up by inflammatory cells which infiltrated the arterial walls and/or the soft tissue mass. These cases indicated that FDG-PET is a useful method for localization of inflammatory lesion in patients with unspecific clinical findings and laboratory data.     

Invited. Takayasu arteritis: MR manifestations and diagnosis of acute and chronic phase

Diagnosis of Takayasu arteritis is difficult because the clinical features are similar to those of other diseases. In the late occlusive or pulseless phase Takayasu arteritis, angiography usually demonstrates luminal changes such as such as stenosis, occlusion, or aneurysmal dilatation of the aorta and pulmonary artery and of their branches. However, absence of such luminal changes does not exclude the possibility of early or systemic phase Takayasu arteritis. Cross-sectional scanning such as CT scan and MRI plays an important role in demonstrating arterial wall changes in the early diagnosis of Takayasu arteritis. Improvement in the clinical findings and subsidence of the active inflammatory process can be expected with early steroid treatment. The common and uncommon MR appearances of the late occlusive phase and the recently described radiographic features of the early systemic phase are illustrated.     

Feasibility of Angioplasty and Stenting for Abdominal Aortic Lesions Adjacent to Previously Stented Visceral Artery Lesions in Patients with Takayasu Arteritis

Two young female patients with Takayasu arteritis presented with symptomatic long-segment abdominal aortic stenosis in the vicinity of previously deployed celiac and renal artery stents that projected markedly into the narrowed aortic lumen. Crushing or distortion of the visceral artery stents during aortic angioplasty was avoided by performing simultaneous or alternating balloon dilatations in the aorta and in the visceral artery stents. Consequently, the visceral artery stents remained patent and shortened longitudinally, allowing unhindered deployment of Wallstents in the adjacent aorta and abolition of a pressure gradient across the aortic lesions. Access to side branches covered by the Wallstent was obtained without difficulty, enabling the performance of balloon dilatation in multiple side branches and ostial stent deployment in a renal artery. These techniques could increase the scope of endovascular therapy in the treatment of patients with Takayasu arteritis.     

Digital subtraction angiography in Takayasu arteritis

The usefulness and limitation of digital subtraction angiography (DSA) in Takayasu arteritis were investigated in 32 patients. Intravenous DSA was particularly useful in the follow-up of patients with an established diagnosis of Takayasu arteritis. Pulmonary arterial involvement could also be demonstrated with intravenous DSA as obstructive arterial changes and lack of accumulation of contrast medium in the pulmonary parenchyma. Detailed information concerning the site and extent of vascular involvement and development of collateral vessels were obtained with intraarterial DSA. Thickening of the thoracic aortic wall, however, could not be recognized with either intravenous or intraarterial DSA. Conventional angiography of the descending thoracic aortal is still required as an initial examination, particularly when there is no aortic arch involvement. However, there is no doubt that DSA has the potential to become the diagnostic procedure of choice in Takayasu arteritis.     

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: 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.     

Percutaneous transluminal angioplasty for carotid artery stenosis in Takayasu arteritis: Persistent benefit over 10 years

A 66-year-old man was admitted to our hospital with right hemiplegia due to a cerebral infarction associated with Takayasu arteritis. We successfully performed percutaneous transluminal angioplasty for stenoses of the innominate and right common carotid arteries. Improvement of the stenotic lesions persisted over 10 years.     

Imaging of large vessel vasculitis with <Superscript>18</Superscript>FDG PET: illusion or reality? A critical review of the literature data

Fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸FDG PET) plays a major role in the management of oncology patients. Owing to the singular properties of the glucose tracer, many patients suffering from non-malignant diseases such as inflammatory or infectious diseases may also derive clinical benefit from the appropriate use of metabolic imaging. Large vessel vasculitides such as giant cell arteritis and Takayasu arteritis are other examples that may potentially extend the field of ¹⁸FDG PET indications. The purpose of the present article is to assess the feasibility of metabolic imaging in vasculitis on the basis of the current literature data. In particular, the clinical context and the ¹⁸FDG imaging patterns seen in patients with large vessel vasculitis are analysed in order to identify potential indications for metabolic imaging.T. Belhocine and D. Blockmans contributed equally to this review article.     

Initial isolated Takayasu's arteritis of the right pulmonary artery: MR appearance

Takayasu's arteritis involves the pulmonary artery tree in more than 50% of the cases. Initial isolated involvement of the pulmonary artery by Takayasu's arteritis, however, is very rare. We report the case of a 34-year-old white woman who presented a clinical and radiographic pattern that mimicked an acute pulmonary embolism with pulmonary infarction. Pulmonary angiography showed stenosis lesions and occlusion of the right pulmonary artery tree. Magnetic resonance imaging demonstrated thickening of the pulmonary artery wall leading to the correct diagnosis Correspondence to: G. Ferretti     

Multiple supra-aortic stenting for Takayasu arteritis: extensive revascularization and two-year follow-up

A patient with Takayasu arteritis with multiple supra-aortic lesions underwent successful treatment with two-staged stent implantation. Stenotic bilateral common carotid, innominate, and left subclavian arteries were dilated, and no restenosis was observed during the follow-up period of 2 years despite recurrent inflammation. Stenting for supra-aortic vessels in cases of Takayasu arteritis has rarely been reported, and to our knowledge, this is the first report of multiple stent placement for all the supra-aortic branches involved.     

Aortic pseudoaneurysm complicating Takayasu disease: CT appearance

The CT findings of a patient with Takayasu arteritis and an ascending aortic pseudoaneurysm are presented. Computed tomography demonstrated the nature, location, and extent of the aortic lesion and revealed the ominous finding of a related large hematoma indicating prior aortic rupture.     

Endomyocardial fibrosis related sudden cardiac death; two autopsied case-reports from Egypt

Endomyocardial fibrosis (EMF) is an idiopathic tropical disorder that is characterized by the development of restrictive cardiomyopathy. Neglected EMF can cause sudden cardiac death (SCD) in adults. Conclusive diagnosis of EMF depends on autopsy after death. In an effort to attract the interest of the community for this rare disease, we report two cases of SCD that were diagnosed as EMF during autopsy in Egypt. Both cases were thoroughly investigated with emphasis on death circumstances and post-mortem anatomical and histopathological findings. The two cases were for adult males presented with SCD following a quarrel with a negative medical history and family history regarding cardiac diseases. No trauma or drug abuse. The autopsy revealed hypertrophied hearts, thick fibrosed endocardium, patchy myocardial fibrosis, and filling of the apex by fibrosis and calcifications. In one of them, there was a huge mural thrombus reaching the level of the mitral valve that totally occluded the cavity of the left ventricle. Histopathologically, fibrosis was confirmed, and no eosinophils were detected. In contrast to previously reported cases in Egypt, the left ventricle was solely affected. Despite the rarity of the disease outside the tropics, the frequency of EMF cases is more likely to be more than the number of reported cases. EMF should be considered as possible cause of SCD during autopsy. Further studies are needed to clarify the etiology and epidemiology of EMF.     

介入治疗在重度头臂型多发性大动脉炎治疗中的应用

目的探讨头臂型大动脉炎介入治疗的方法,围术期观察及疗效。方法回顾性分析19例重型头臂型多发性大动脉炎患者的临床资料。结果 19例24根目标血管中,血管开通技术成功率91.67%(22/24)。仅1例发生右大脑中动脉栓塞。18例脑缺血症状明显缓解。17例随访8个月～3年,平均(19.42±2.31)个月,其中1例患者术后22个月突发枕叶梗死。8例患者偶有头晕发生。结论腔内介入手术是治疗重型头臂型多发性大动脉炎的一种安全有效方法。