Multimodality imaging in Takayasu’s arteritis: A Comprehensive Review

Congress:

ECR 2020

Poster Number:

C-08116

Type:

Educational Exhibit

Keywords:

Not applicable, Inflammation, Diagnostic procedure, PET-CT, MR-Angiography, CT-Angiography, Vascular, Arteries / Aorta

Authors:

A. Ribrag¹, C. Cholet¹, A. mekinian¹, O. fain¹, L. MONNIER-CHOLLEY¹, L. Arrivé²; ¹PARIS/FR, ²Saint Mandé/FR

DOI:

10.26044/ecr2020/C-08116

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-08116

Fig. 1: ACR diagnostic criteria for Takayasu's arteritis included clinical features and...

Fig. 2: Classification of Takayasu arteritis according to arterial lesions distribution...

Fig. 3: Post-contrast CT, axial views. (a) Aneurysm of the ascending aorta associated...

Fig. 4: Post-contrast T1-weighted MRI, axial view. Typical “double ring” sign...

Fig. 5: T2w TSE MRI, axial views. (a) Circumferential wall thickening of the descending...

Fig. 6: FLAIR, axial view (a). Circumferential wall thickening of the right internal...

Fig. 7: Post-contrast CT, axial view (a). Concentric circumferential wall thickening of...

Fig. 8: Post-contrast MRA (a) and post-contrast CT (b), coronal views, MIP...

Fig. 9: Post-contrast CT, coronal view (a and b). Significant stenosis of the...

Fig. 10: Post-contrast CT, sagittal MIP reconstructions (a) and axial views (b and c)....

Fig. 11: Post-contrast CT, coronal view, MIP reconstruction (a). Stenosis of the origin...

Fig. 12: Post-contrast T1w MRI, axial view (a). Concentric circumferential wall...

Learning objectives

1.Define Takayasu’s arteritis (TA): epidemiology, pathophysiology, and common clinical features. 2.Describe the optimal imaging protocol to explore patients with TAusing computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). 3.Identify the CT, MRI, and PET features of arterial and extra-arterial involvement in TA. 4.Identify imaging features that may differentiate TAfrom atherosclerosis and giant cell arteritis. 5.Identify imaging markers associated with disease activity.

Background

A.Definition Takayasu’s arteritis (TA) is a rare chronic idiopathic large vessel vasculitis that primarily involves the aorta and its main branches, and less frequently the pulmonary and coronary arteries. TA preferentially affects young women in the second and third decades of life and is most common in people with Asian ethnicity. B.Pathophysiology Histopathologic features include granulomatous panarteritis with lymphomonocytic infiltration. Initial intimal inflammation and proliferation, eventually evolving into fibrosis, leads to arterial wall thickening and stenosis. Destruction of the elastic and muscular layers leads to...

Findings and procedure details

I.Imaging techniques in Takayasu’s arteritis In 2018, guidelines for the use of imaging in large vessel vasculitis were issued by the European League Against Rheumatism (EULAR), precising imaging indications and multimodality protocols. A.Imaging Indications a. Diagnosis Because clinical findings and biological test results are non-specific to TA, and because invasive arterial biopsy is not an option,imaging is recommended fordiagnosis and evaluation of arterial involvement. b. Follow-up Imaging should not be obtained systematically as part of routine follow-up. Only clinical or biological suspicion of disease relapse...

Conclusion

Multimodality imaging features to assess diagnosis in TA are well established. Further studies are needed to assess the accuracy of imaging features of disease activity as well as to identify imaging markers associated with prognosis.

Personal information and conflict of interest

A. Ribrag; Paris/FR - nothing to disclose C. Cholet; Paris/FR - nothing to disclose A. Mekinian; Paris/FR - nothing to disclose O. Fain; Paris/FR - nothing to disclose L. Monnier-Cholley; Paris/FR - nothing to disclose L. Arrive; Saint Mandé/FR - nothing to disclose

References

1.Choe YH, Han BK, Koh EM, et al. Takayasu’s arteritis: assessment of disease activity with contrast-enhanced MR imaging.AJR Am J Roentgenol. 2000;175(2):505-511. 2.Kato Y, Terashima M, Ohigashi H, et al. Vessel Wall Inflammation of Takayasu Arteritis Detected by Contrast-Enhanced Magnetic Resonance Imaging: Association with Disease Distribution and Activity.PLoS One. 2015;10(12):e0145855. 3.Tso E, Flamm SD, White RD, et al. Takayasu arteritis: utility and limitations of magnetic resonance imaging in diagnosis and treatment.Arthritis Rheum. 2002;46(6):1634-1642. 4.Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the...