Purpose:
1. Is a low dose whole aortic angio CT feasible with an acceptable ionizing radiation dose in these young patients?
2. Identify radiologic signs of inflammatory activity of the disease.
Material and methods:
•Prospective and descriptive study.
•From January 2014 to December 2015.
•Patients corresponding to 1990 ACR criteria.
•Excluding criteria:
- Pathologyproof of Horton, infectiousaortitis.
- Contra-indications to medical imaging management (contrast media injection, pregnancy…)
Angio-CT
•320 rowsCT.•Triphasic: NC, Arterial, Late acquisition at 5mn.
•Arterial: ECG synchronization at thoracic floor.
•Injection of 2ml/kg at 5cc/s rate, of contrast media (300 mmol/ml).
•A « low dose » protocol: 80Kv, automatic adaptation of mAs, was done when possible:« BMI inferior to 25 ». In this case, we used « AIDR 3D »to treat reformatted data.
•Comparison of the ordinary and low dose protocols (quality of enhancement vs irradiation)
•Endoluminalvascular abnormalities (stenosis, occlusion, dilatation).•Arterial wall abnormalities: Thickening, late parietal enhancement.
•Statistic correlation between parietal modifications and inflammatory status.Results and discussion:
37 pan aortic angio-CT in 37 patients.
4 patients excluded è 02 Horton disease.
è 02 sub-acute post-embolic subclavian arteries occlusion.
33 Patients with high suspicion of Takayasu disease according to the 1990 ACR criteria.
Age and sex
Stenosis distribution
50% of the stenosis were detected in the supra aortic arteries
Occlusion distribution
25% of the occlousions were detected at the subclavian arteries
Aneurysm distribution
50% of the aneurisms were detected at in the ascending aorta and pulmonary artery.
Lupi-Herrera Classification
|
Japan
(Hata)
[1996]
|
Mexique
(Soto)
[1976/03]
|
France
(Arnaud)
[1995/06]
|
Our study 2013/16
|
Angio
|
Include WT
|
Type I
|
24
|
19
|
20
|
56.7
|
23
|
Type IIa
|
11
|
3
|
0
|
6.7
|
3
|
Type IIb
|
10
|
4
|
5
|
3.3
|
6
|
Type III
|
0
|
4
|
5
|
0
|
3
|
Type IV
|
1
|
2
|
5
|
20
|
9
|
Type V
|
42
|
69
|
65
|
13
|
54
|
1990 ACR criteria table
ACR 1990
|
|
Age inferior or equal to 40 years old
|
66.9 %
|
Extremities claudication
|
40 %
|
Brachial pulse abolition
|
37 %
|
Anisotension
|
43.3 %
|
Subclavian or aortic wheezing
|
23.3 %
|
Radiologic modifications*
|
70% *
|
ACR 1990
|
|
Radiologic findings (Including wall thickening)
|
70% (100 %)
|
Wall thickening is a common finding but not included beyound the 1990 ACR criterias
Late enhancement
|
|
|
|
|
|
Double ring LE
|
Total
|
Present
|
absent
|
VS/CRP
|
+
|
8
|
3
|
11
|
80 %
|
14.3 %
|
33.3 %
|
-
|
2
|
20
|
22
|
20 %
|
85.7 %
|
66.7 %
|
|
Vascular enhancement quality
|
protocol
|
N
|
Mean
|
Vascular enhancement
|
Low dose
|
15
|
3.7863
|
Ordinary protocol
|
18
|
3.8890
|
Irradiation
|
DLP low dose (mGy.cm)
|
CTDIvollow dose (mGy.cm)
|
DLP ordinary protocol (mGy.cm)
|
CTDIvolordinary protocol (mGy.cm)
|
Effective Dose low dose (mSv)
|
Effective Dose ordinary (mSv)
|
N
|
15
|
15
|
18
|
18
|
15
|
18
|
Mean
|
1257.3077
|
64.6154
|
3307.0556
|
147.4118
|
20.4
|
46.53
|
P < 0.001
•Significant statistic difference between low dose and ordinary protocol (p < 0.0001)
•Effective dose half with a low dose protocol (20 mSv vs 46 mSv).
•With no compromise on the quality of the lecture (P>0.05).