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Tian X, Zeng X. Chinese guideline for the diagnosis and treatment of Takayasu's arteritis (2023). RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2024; 5:5-26. [PMID: 38571931 PMCID: PMC10985707 DOI: 10.1515/rir-2024-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 02/19/2024] [Indexed: 04/05/2024]
Abstract
Takayasu's arteritis (TAK) is a chronic granulomatous inflammatory disease that involves aorta and its primary branches. It is characterized by wall thickening, stenosis/obliteration or aneurysm formation of the involved arteries. In order to standardize the diagnosis and treatment of TAK in China, a clinical practice guideline with an evidence-based approach is developed under the leadership of National Clinical Medical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID). Eleven recommendations for 11 clinical questions that are important to the diagnosis and treatment of TAK are developed based on the latest evidence and expert opinions combined with real clinical practice in China.
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Affiliation(s)
- Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science& Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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2
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Casteleyn V, Schmidt WA. [Imaging of large vessel vasculitis]. Z Rheumatol 2023; 82:646-653. [PMID: 37620546 DOI: 10.1007/s00393-023-01405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 08/26/2023]
Abstract
Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are the most important primary large vessel vasculitides. A rapid and reliable confirmation of the diagnosis is necessary to prevent ischemic complications. Patients with extracranial GCA and TAK often present with unspecific symptoms. Since 2018 the EULAR has recommended imaging as an alternative to histology for confirming the diagnosis. Ultrasound is particularly recommended as the primary imaging modality for cranial GCA. Alternatively, MRI and PET can be used for the diagnostics of temporal arteritis. Ultrasound is also valuable for extracranial GCA, alternatively MRI, CT or PET-CT can be used. This review discusses the current status of imaging techniques in large vessel vasculitis as well as the advantages and disadvantages. The focus is on ultrasound, which is increasingly being used as the primary diagnostic modality due to its excellent diagnostic quality, wide availability, noninvasiveness, and patient friendliness. Technical aspects, prerequisites, and normal and pathological findings are also presented. Finally, an outlook is given on promising new developments, such as scores for evaluating disease progression and contrast-enhanced ultrasound.
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Affiliation(s)
- Vincent Casteleyn
- Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Wolfgang Andreas Schmidt
- Abteilung Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Standort Berlin-Buch, Lindenberger Weg 19, 13125, Berlin, Deutschland
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Dong Y, Wang Y, Wang Y, Tian X, Li J, Yang Y, Ge Z, Zhang L, Zou M, Wang H, Li J. Ultrasonography and contrast-enhanced ultrasound for activity assessment in 115 patients with carotid involvement of Takayasu arteritis. Mod Rheumatol 2023; 33:1007-1015. [PMID: 36130241 DOI: 10.1093/mr/roac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/22/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the efficacy of ultrasound and contrast-enhanced ultrasound (CEUS) in disease activity assessment of Takayasu arteritis (TA) with carotid involvement. METHODS This is a cohort study of 115 patients of TA with carotid involvement. We investigated correlations between clinical data, sonographic features, and CEUS enhancement at the site most prominent lesion of each patient. Disease activity was assessed by the National Institute of Health Kerr criteria. Sonographic findings were compared with follow-up examinations. CEUS was repeated after a 3-7 months interval in 35 patients to evaluate change of CEUS enhancement after treatment. RESULTS Extensiveness of CEUS enhancement at most prominent carotid lesions had significant correlations with disease activity by the Kerr criteria (P < .001). The specificity of extensive enhancement for indicating active disease was 95%, while sensitivity was 67%. Patients with active disease showed greater arterial wall thickness and more prominent reduction of arterial wall thickness after treatment. Most of the patients (68%) with subsided active disease after treatment featured decrease of CEUS enhancement. CONCLUSIONS Extensiveness of enhancement by CEUS and arterial wall thickness by ultrasonography may be useful markers for initial and follow-up assessment of disease activity of TA with common carotid artery involvement.
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Affiliation(s)
- Yifan Dong
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, and Peking Union Medical College, Beijing, China
| | - Yahong Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, and Peking Union Medical College, Beijing, China
| | - Ying Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, and Peking Union Medical College, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science and Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jing Li
- Department of Rheumatology and Clinical Immunology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science and Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yunjiao Yang
- Department of Rheumatology and Clinical Immunology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science and Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Zhitong Ge
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, and Peking Union Medical College, Beijing, China
| | - Mi Zou
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, and Peking Union Medical College, Beijing, China
| | - Hongyan Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, and Peking Union Medical College, Beijing, China
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Fu Y, Chen Y. Operative experience on descending aorta with Takayasu Arteritis: a review. Front Cardiovasc Med 2023; 10:1181285. [PMID: 37416916 PMCID: PMC10320220 DOI: 10.3389/fcvm.2023.1181285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Patients with Takayasu arteritis (TA) and descending aorta involvement often experience insidious onset and slow progression, leading to irreversible vascular lesions despite medication therapy. Surgical management plays a crucial role in resolving hemodynamic disturbances and has shown promise in improving the outcomes of this patient population, owing to significant advancements in surgical expertise. However, studies focusing on this rare disease are lacking. This review summarizes the characteristics of patients with stenosis in descending aorta, emphasizing surgical approaches, perioperative management, and disease outcomes. The operative approach depends on lesion location and extent. Existing studies have confirmed that the choice of surgical modality significantly influences postoperative complications and long-term prognosis in patients, highlighting the effectiveness of bypass surgery as a favorable option in clinical practice with a satisfactory long-term patency rate. To mitigate postoperative complications, it is advisable to conduct regular imaging follow-ups to prevent the deterioration of the condition. Notably, the occurrence of restenosis and pseudoaneurysm formation deserves particular attention due to their impact on patient survival. The use of perioperative medication remains a topic of debate, as previous studies have presented divergent perspectives. The primary objective of this review is to provide a comprehensive perspective on surgical treatment and offer customized surgical approaches for patients in this population.
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Espitia O, Robin O, Hersant J, Roncato C, Théry A, Vibet MA, Gautier G, Raimbeau A, Lapébie FX. Inter and intra-observer agreement of arterial wall contrast-enhanced ultrasonography in giant cell arteritis. Front Med (Lausanne) 2022; 9:1042366. [DOI: 10.3389/fmed.2022.1042366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022] Open
Abstract
ObjectiveThe aim of this study was to analyze inter- and intra-observer agreement for contrast-enhanced ultrasonography (CEUS) for monitoring disease activity in Giant Cell Arteritis (GCA) in the wall of axillary arteries, and common carotid arteries.MethodsGiant cell arteritis patients have CEUS of axillary arteries and common carotid. These images were rated by seven vascular medicine physicians from four hospitals who were experienced in duplex ultrasonography of GCA patients. Two weeks later, observers again rated the same images. GCA patients were recruited in from December 2019 to February 2021. An analysis of the contrast of the ultrasound images with a gradation in three classes (grade 0, 1, and 2) was performed. Grade 0 corresponds to no contrast, grade 1 to moderate wall contrast and grade 2 to intense contrast. A new analysis in 2 classes: positive or negative wall contrast; was then performed on new series of images.ResultsSixty arterial segments were evaluated in 30 patients. For the three-class scale, intra-rater agreement was substantial: κ 0.70; inter-rater agreement was fair: κ from 0.22 to 0.27. Thirty-four videos had a wall thickness of less than 2 mm and 26 videos had a wall thickness greater than 2 mm. For walls with a thickness lower than 2 mm: intra-rater agreement was substantial: κ 0.69; inter-rater agreement was fair: κ 0.35. For walls with a thickness of 2 mm or more: intra-rater agreement was substantial: κ 0.53; inter-rater agreement was fair: κ 0.25. For analysis of parietal contrast uptake in two classes: inter-rater agreement was fair to moderate: κ from 0.35 to 0.41; and for walls with a thickness of 2 mm or more: inter-rater agreement was fair to substantial κ from 0.22 to 0.63.ConclusionThe visual analysis of contrast uptake in the wall of the axillary and common carotid arteries showed good intra-rater agreement in GCA patients. The inter-rater agreement was low, especially when contrast was analyzed in three classes. The inter-rater agreement for the analysis in two classes was also low. The inter-rater agreement was higher in two-class analysis for walls of 2 mm thickness or more.
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Misra DP, Jain N, Ora M, Singh K, Agarwal V, Sharma A. Outcome Measures and Biomarkers for Disease Assessment in Takayasu Arteritis. Diagnostics (Basel) 2022; 12:diagnostics12102565. [PMID: 36292253 PMCID: PMC9601573 DOI: 10.3390/diagnostics12102565] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 12/05/2022] Open
Abstract
Takayasu arteritis (TAK) is a less common large vessel vasculitis where histopathology of involved arteries is difficult to access except during open surgical procedures. Assessment of disease activity in TAK, therefore, relies on surrogate measures. Clinical disease activity measures such as the National Institutes of Health (NIH) score, the Disease Extent Index in TAK (DEI.TAK) and the Indian TAK Clinical Activity Score (ITAS2010) inconsistently associate with acute phase reactants (APRs). Computerized tomographic angiography (CTA), magnetic resonance angiography (MRA), or color Doppler Ultrasound (CDUS) enables anatomical characterization of stenosis, dilatation, and vessel wall characteristics. Vascular wall uptake of 18-fluorodeoxyglucose or other ligands using positron emission tomography computerized tomography (PET-CT) helps assess metabolic activity, which reflects disease activity well in a subset of TAK with normal APRs. Angiographic scoring systems to quantitate the extent of vascular involvement in TAK have been developed recently. Erythrocyte sedimentation rate and C-reactive protein have a moderate performance in distinguishing active TAK. Numerous novel biomarkers are under evaluation in TAK. Limited literature suggests a better assessment of active disease by combining APRs, PET-CT, and circulating biomarkers. Validated damage indices and patient-reported outcome measures specific to TAK are lacking. Few biomarkers have been evaluated to reflect vascular damage in TAK and constitute important research agenda.
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
- Correspondence: (D.P.M.); (A.S.)
| | - Neeraj Jain
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Manish Ora
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Kritika Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Aman Sharma
- Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
- Correspondence: (D.P.M.); (A.S.)
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Kirby C, Flood R, Mullan R, Murphy G, Kane D. Evolution of ultrasound in giant cell arteritis. Front Med (Lausanne) 2022; 9:981659. [PMID: 36262280 PMCID: PMC9574015 DOI: 10.3389/fmed.2022.981659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Ultrasound (US) is being increasingly used to diagnose Giant Cell Arteritis (GCA). The traditional diagnostic Gold Standard has been temporal artery biopsy (TAB), but this is expensive, invasive, has a false-negative rate as high as 60% and has little impact on clinical decision-making. A non-compressible halo with a thickened intima-media complex (IMC) is the sonographic hallmark of GCA. The superficial temporal arteries (STA) and axillary arteries (AA) are the most consistently inflamed arteries sonographically and imaging protocols for evaluating suspected GCA should include at least these two arterial territories. Studies evaluating temporal artery ultrasound (TAUS) have varied considerably in size and methodology with results showing wide discrepancies in sensitivity (9–100%), specificity (66–100%), positive predictive value (36–100%) and negative predictive value (33–100%). Bilateral halos increase sensitivity as does the incorporation of pre-test probability, while prior corticosteroid use decreases sensitivity. Quantifying sonographic vasculitis using Halo Counts and Halo Scores can predict disease extent/severity, risk of specific complications and likelihood of treatment response. Regression of the Halo sign has been observed from as little as 2 days to as late as 7 months after initiation of immunosuppressive treatment and occurs at different rates in STAs than AAs. US is more sensitive than TAB and has comparable sensitivity to MRI and PET/CT. It is time-efficient, cost-effective and allows for the implementation of fast-track GCA clinics which substantially mitigate the risk of irreversible blindness. Algorithms incorporating combinations of imaging modalities can achieve a 100% sensitivity and specificity for a diagnosis of GCA. US should be a standard first line investigation in routine clinical care of patients with suspected GCA with TAB reserved only for those having had a normal US in the context of a high pre-test probability.
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Affiliation(s)
- Colm Kirby
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland,Department of Rheumatology, Cork University Hospital and University College Cork, Cork, Ireland,*Correspondence: Colm Kirby
| | - Rachael Flood
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland
| | - Ronan Mullan
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland
| | - Grainne Murphy
- Department of Rheumatology, Cork University Hospital and University College Cork, Cork, Ireland
| | - David Kane
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland
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Li X, Cokkinos D, Gadani S, Rafailidis V, Aschwanden M, Levitin A, Szaflarski D, Kirksey L, Staub D, Partovi S. Advanced ultrasound techniques in arterial diseases. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1711-1721. [PMID: 35195805 DOI: 10.1007/s10554-022-02558-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/08/2022] [Indexed: 12/24/2022]
Abstract
Ultrasound (US) remains a valuable modality for the assessment of vascular diseases, with conventional sonographic techniques such as grayscale and Doppler US used extensively to assess carotid atherosclerosis and abdominal aortic aneurysms. However, conventional US techniques are inherently limited by factors such as operator dependency and limited field of view. There is an increasing interest in the use of advanced sonographic techniques such as contrast-enhanced US (CEUS) and 3-dimensional (3D) US to mitigate some of these limitations. Clinical applications of advanced sonographic techniques include surveillance of abdominal aortic aneurysm, post-endovascular aortic repair, and carotid atherosclerotic plaques. Recently published studies have demonstrated that CEUS and 3D US are superior to conventional US and comparable to computed tomography for certain vascular applications. Further research is required to fully validate the application of advanced sonographic techniques in evaluating various atherosclerotic diseases.
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Affiliation(s)
- Xin Li
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sameer Gadani
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Vasileios Rafailidis
- Department of Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Markus Aschwanden
- Department of Vascular Medicine/Angiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Abraham Levitin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Diane Szaflarski
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Levester Kirksey
- Department of Vascular Surgery, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Daniel Staub
- Department of Vascular Medicine/Angiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the recent advances in Takayasu arteritis (TAK), mainly focusing on pathogenesis, imaging modalities, and management. RECENT FINDINGS Three novel clusters based on angiographic findings were identified in the Indian cohort and replicated in the North American cohorts. Different new imaging modalities have been tried in the assessment of arterial inflammation with promising results. There is more evidence on the long-term use of tocilizumab, but relapses are common. In light of the recent findings on the pathogenesis of TAK, Janus kinase inhibitors seem to be promising. SUMMARY Improvement in imaging modalities and in our understanding of the disease pathogenesis will allow us to better assess the disease activity and identify effective therapeutic agents.
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Affiliation(s)
| | - Gulen Hatemi
- Department of Medicine, Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Bergner R, Splitthoff J, Wadsack D. Use of Contrast-Enhanced Ultrasound Sonography in Giant Cell Arteritis: A Proof-of-Concept Study. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:143-148. [PMID: 34702639 DOI: 10.1016/j.ultrasmedbio.2021.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
C-Reactive protein and erythrocyte sedimentation rate are crucial parameters used to monitor giant cell arteritis (GCA). Given that tocilizumab is approved for the treatment of GCA, these parameters are less sensitive because of the effects of interleukin-6 receptor blockade. Thus, the optimal method for monitoring GCA patients undergoing tocilizumab therapy, especially patients exhibiting a persistent thickened vessel wall in large vessels, remains unclear. Contrast-enhanced ultrasonography (CEUS) can increase the visibility of tissue perfusion by slow blood flow, which cannot be detected by power color doppler. We used CEUS to investigate patients with active and inactive GCA of the large vessels (active large vessel arteritis [aLVV]/inactive large vessel arteritis [iLVV]) who were not administered tocilizumab in this proof-of-concept study. After injection of the ultrasound contrast agent, the contrasted area (CA) of large vessels in a transverse section was calculated twice: first when the lumen was contrasted completely and once again 4-8 s later. We investigated the value of increase in CA that exhibited the best sensitivity and specificity for aLVV. Twenty-four patients were included in this study: 15 with aLVV and 9 with iLVV. The CA increased from 32.2 ± 16.8 to 52.5 ± 21.3 mm2 (p < 0.0001) in aLVV. The mean CA remained unchanged in iLVV. The best cutoff value to differentiate between aLVV and iLVV was a ≥25% increase in CA with a sensitivity and specificity of 91.7% and 100%, respectively. Our study indicates that CEUS can detect aLVV with high sensitivity and specificity. Incorporation of CEUS into routine clinical practice might result in a good method for monitoring disease activity in LVV in GCA patients. The limitation of our study was the small number of patients and the lack of investigator blinding to clinical data.
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Affiliation(s)
- Raoul Bergner
- Medizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany.
| | - Jan Splitthoff
- Medizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany
| | - Daniel Wadsack
- Medizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany
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Aeschlimann FA, Raimondi F, Leiner T, Aquaro GD, Saadoun D, Grotenhuis HB. Overview of imaging in adult- and childhood-onset Takayasu arteritis. J Rheumatol 2021; 49:346-357. [PMID: 34853087 DOI: 10.3899/jrheum.210368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/22/2022]
Abstract
Takayasu Arteritis is an idiopathic large vessel vasculitis, that affects young adults and children and can lead to ischemia and end-organ damage. Vascular imaging is crucial for diagnosis, assessment of disease extent and management of the disease. In this article, we critically review evidence for the clinical use of the different imaging modalities conventional angiography, magnetic resonance imaging, computed tomography, Doppler ultrasound and 18fluorodeoxyglucose positron emission tomography. We thereby focus on their clinical applicability, challenges and specific use in children.
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Affiliation(s)
- Florence A Aeschlimann
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Francesca Raimondi
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Tim Leiner
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Giovanni Donato Aquaro
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - David Saadoun
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Heynric B Grotenhuis
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
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Jianu DC, Jianu SN, Dan TF, Munteanu G, Bîrdac CD, Motoc AGM, Docu Axelerad A, Petrica L, Gogu AE. Ultrasound Technologies and the Diagnosis of Giant Cell Arteritis. Biomedicines 2021; 9:biomedicines9121801. [PMID: 34944617 PMCID: PMC8698303 DOI: 10.3390/biomedicines9121801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/21/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022] Open
Abstract
Giant cell arteritis (GCA) is a primary autoimmune vasculitis that specifically affects medium-sized extracranial arteries, like superficial temporal arteries (TAs). The most important data to be considered for the ultrasound (US) diagnosis of temporal arteritis are stenosis, acute occlusions and “dark halo” sign, which represent the edema of the vascular wall. The vessel wall thickening of large vessels in GCA can be recognized by the US, which has high sensitivity and is facile to use. Ocular complications of GCA are common and consist especially of anterior arterial ischemic optic neuropathies or central retinal artery occlusion with sudden, painless, and sharp loss of vision in the affected eye. Color Doppler imaging of the orbital vessels (showing low-end diastolic velocities and a high resistance index) is essential to quickly differentiate the mechanism of ocular involvement (arteritic versus non-arteritic), since the characteristics of TAs on US do not correspond with ocular involvement on GCA. GCA should be cured immediately with systemic corticosteroids to avoid further visual loss of the eyes.
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Affiliation(s)
- Dragoș Cătălin Jianu
- Department of Neurosciences-Division of Neurology, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (D.C.J.); (A.E.G.)
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, 300041 Timișoara, Romania
| | - Silviana Nina Jianu
- Department of Internal Medicine II, Centre for Molecular Research in Nephrology and Vascular Pathology, Victor Babeş University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Traian Flavius Dan
- Department of Neurosciences-Division of Neurology, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (D.C.J.); (A.E.G.)
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, 300041 Timișoara, Romania
- Correspondence: (T.F.D.); (G.M.); Tel.: +40-745035178 (T.F.D.); +40-746151426 (G.M.)
| | - Georgiana Munteanu
- Department of Neurosciences-Division of Neurology, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (D.C.J.); (A.E.G.)
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, 300041 Timișoara, Romania
- Department of Internal Medicine II, Centre for Molecular Research in Nephrology and Vascular Pathology, Victor Babeş University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (T.F.D.); (G.M.); Tel.: +40-745035178 (T.F.D.); +40-746151426 (G.M.)
| | - Claudiu Dumitru Bîrdac
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, 300041 Timișoara, Romania
| | - Andrei Gheorghe Marius Motoc
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- Department of Anatomy and Embryology, Victor Babeş University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Any Docu Axelerad
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- Department of Neurology, General Medicine Faculty, Ovidius University, 900527 Constanța, Romania
| | - Ligia Petrica
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- Department of Internal Medicine II-Division of Nephrology, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Anca Elena Gogu
- Department of Neurosciences-Division of Neurology, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (D.C.J.); (A.E.G.)
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania; (C.D.B.); (A.G.M.M.); (A.D.A.); (L.P.)
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, 300041 Timișoara, Romania
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Aghayev A, Steigner ML, Azene EM, Burns J, Chareonthaitawee P, Desjardins B, El Khouli RH, Grayson PC, Hedgire SS, Kalva SP, Ledbetter LN, Lee YJ, Mauro DM, Pelaez A, Pillai AK, Singh N, Suranyi PS, Verma N, Williamson EE, Dill KE. ACR Appropriateness Criteria® Noncerebral Vasculitis. J Am Coll Radiol 2021; 18:S380-S393. [PMID: 34794595 DOI: 10.1016/j.jacr.2021.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 10/19/2022]
Abstract
Noncerebral vasculitis is a wide-range noninfectious inflammatory disorder affecting the vessels. Vasculitides have been categorized based on the vessel size, such as large-vessel vasculitis, medium-vessel vasculitis, and small-vessel vasculitis. In this document, we cover large-vessel vasculitis and medium-vessel vasculitis. Due to the challenges of vessel biopsy, imaging plays a crucial role in diagnosing this entity. While CTA and MRA can both provide anatomical details of the vessel wall, including wall thickness and enhancement in large-vessel vasculitis, FDG-PET/CT can show functional assessment based on the glycolytic activity of inflammatory cells in the inflamed vessels. Given the size of the vessel in medium-vessel vasculitis, invasive arteriography is still a choice for imaging. However, high-resolution CTA images can depict small-caliber aneurysms, and thus can be utilized in the diagnosis of medium-vessel vasculitis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Ayaz Aghayev
- Panel Vice-Chair, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Michael L Steigner
- Panel Chair; and Vascular CT and MR, and Medical Director 3D Lab, Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Judah Burns
- Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | | | | | - Riham H El Khouli
- Director, Theranostic Program and Chair, NM&MI Clinical Protocol and Quality Improvement (CPQI) Committee, University of Kentucky, Lexington, Kentucky
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, Rheumatologist
| | - Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sanjeeva P Kalva
- Chief, Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts; International Editor, Journal of Clinical Interventional Radiology ISVIR; and Assistant Editor, Radiology - Cardiothoracic, RSNA
| | - Luke N Ledbetter
- Director, Head and Neck Imaging, University of California Los Angeles, Los Angeles, California
| | - Yoo Jin Lee
- University of California San Francisco, San Francisco, California
| | - David M Mauro
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Andres Pelaez
- Director, Lung Transplant Program, University of Florida Gainesville, Gainesville, Florida; and Primary care physician
| | - Anil K Pillai
- Section Chief, UT Southwestern Medical Center, Dallas, Texas
| | | | - Pal S Suranyi
- Medical University of South Carolina, Charleston, South Carolina
| | - Nupur Verma
- Program Director, Department of Radiology, University of Florida, Gainesville, Florida
| | - Eric E Williamson
- Mayo Clinic, Rochester, New York, Society of Cardiovascular Computed Tomography
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
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Abstract
PURPOSE OF REVIEW Aortitis is the inflammation of the aorta due to various causes. Clinical presentations vary as well as the imaging findings. Exact pathogenetic mechanisms or triggering factors, as well as the best diagnostic and monitoring modalities and treatment strategies, are yet to be elucidated. We reviewed recent studies in aortitis and associated diseases. RECENT FINDINGS Multiple cohort studies reporting long-term outcomes in patients with noninfectious aortitis were recently published. Comparative features of isolated aortitis were described. Six angiographic clusters for giant cell arteritis and Takayasu have been identified. New classification criteria have been proposed for IgG4-related disease by a data-driven method. The ultrasonographic slope sign and a halo score were described as specific imaging parameters in giant cell arteritis. The promising role of PET-computed tomography, not only in the diagnosis of aortitis but also in monitoring disease activity, has been noted. Results of in-vitro studies on Janus kinase (JAK)/signal transducers and activators of transcription and mammalian target of rapamycin (mTOR) pathways, comparative studies with leflunomide as an induction therapy, and a long-term follow-up study with tocilizumab may contribute to the management of Takayasu arteritis. SUMMARY An impressive number of studies have addressed aortitis in recent years. However, there still is a lack of robust data on causes, monitoring disease activity by imaging and biomarkers, and drugs providing steroid-free remission in noninfectious aortitis.
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Jia S, Liu L, Ma J, Chen X. Application progress of multiple imaging modalities in Takayasu arteritis. Int J Cardiovasc Imaging 2021; 37:3591-3601. [PMID: 34287748 DOI: 10.1007/s10554-021-02348-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/12/2021] [Indexed: 02/05/2023]
Abstract
Takayasu arteritis (TA) is a chronic, idiopathic, granulomatous large vessel vasculitis of unknown etiology. The clinical manifestations of TA are incredibly variable, mainly depending on the location of the lesions. In the light of its insidious progress and the diversity of clinical manifestations, a substantial proportion of patients might experience a considerable delay in diagnosis, which leads to irreversible malignant complications, highlighting the importance of early diagnosis. There has been accumulating evidence that early identification of disease is pivotal to initiate timely therapy and ameliorate the prognosis. Therefore, this review discusses and summarizes the latest evidence on the application progress of multiple imaging modalities.
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Affiliation(s)
- Shanshan Jia
- Department of Cardiology, West China Hospital of Sichuan University, Guo Xue Xiang No.37, Chengdu, Sichuan, 610041, China
| | - Lu Liu
- Department of Cardiology, West China Hospital of Sichuan University, Guo Xue Xiang No.37, Chengdu, Sichuan, 610041, China
| | - Jun Ma
- Department of Cardiology, West China Hospital of Sichuan University, Guo Xue Xiang No.37, Chengdu, Sichuan, 610041, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital of Sichuan University, Guo Xue Xiang No.37, Chengdu, Sichuan, 610041, China.
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Abstract
A young pregnant woman, G2P1L1, was admitted for safe confinement at 40 weeks of gestation with Takayasu arteritis. She was diagnosed with Takayasu arteritis in 2016 when she had polyarthritis, hypertension and asymmetrical peripheral pulses. Her CT angiogram showed involvement of branches of aortic arch and coeliac trunk. She had mild pulmonary hypertension and was classified as type V disease (P)+. She was started on immunosuppressant medication and achieved a fair control of symptoms and disease activity. She gave history of treatment for pulmonary tuberculosis for 6 months in 2016 after which she developed polyarthralgia. She is currently asymptomatic and had mild hypertension that was controlled. She was evaluated for evidence of aneurysms/thrombus/aortic insufficiency and taken up for elective caesarean in view of type V disease. Maternal and perinatal outcome was good and she was discharged on her regular medication as per immunology opinion.
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Affiliation(s)
- Papa Dasari
- Obstetrics and Gynaecology, JIPMER, Puducherry, Tamil Nadu, India
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Huang Y, Ma X, Li M, Dong H, Wan Y, Zhu J. Carotid contrast-enhanced ultrasonographic assessment of disease activity in Takayasu arteritis. Eur Heart J Cardiovasc Imaging 2020; 20:789-795. [PMID: 30590495 DOI: 10.1093/ehjci/jey197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 11/13/2018] [Accepted: 11/23/2018] [Indexed: 11/14/2022] Open
Abstract
AIMS To investigate the usefulness of carotid contrast-enhanced ultrasound (CEUS) in assessment of disease activity in patients with Takayasu arteritis (TA). METHODS AND RESULTS After screening 219 CEUS records from 124 consecutive patients followed at our clinic between October 2014 and May 2018, data were analysed from 159 carotid CEUS from 86 patients diagnosed with Type I TA. Patients were categorized based on disease activity according to National Institutes of Health criteria into two groups: active disease group (92 CEUS) and non-active disease group (67 CEUS). The enhanced intensity of carotid artery wall: (i) was higher in active disease group than in non-active disease group (3.09 ± 1.67 dB vs. 1.44 ± 1.29 dB, P < 0.0001, respectively); and (ii) had a high predictive value for TA disease activity with area under the curve (AUC) of 86.3% [95% confidence interval (CI) 79.7-92.9], sensitivity of 88.0%, and specificity of 79.1%. The latter AUC was not significantly affected (P > 0.05) when erythrocyte sedimentation rate, C-reactive protein level, or arterial wall thickness were added to assessment of disease activity in TA. CONCLUSION Carotid vascularization by CEUS, as sole inflammatory marker, had a high predictive value for disease activity in Type I TA.
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Affiliation(s)
- Yanli Huang
- Department of Ultrasonography, The First Affiliated Hospital of Dalian Medical University, No 222, Zhongshan Road, Xigang District, Dalian, China
| | - Xiaohui Ma
- Department of Vascular Surgery, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, China
| | - Min Li
- Department of Ultrasonography, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, China
| | - Huiwu Dong
- Department of Ultrasonography, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, China
| | - Yuehua Wan
- Department of Rheumatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, China
| | - Jian Zhu
- Department of Rheumatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, China
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Schäfer VS, Jin L, Schmidt WA. Imaging for Diagnosis, Monitoring, and Outcome Prediction of Large Vessel Vasculitides. Curr Rheumatol Rep 2020; 22:76. [PMID: 32959107 PMCID: PMC7505874 DOI: 10.1007/s11926-020-00955-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose of Review To discuss and summarize the latest evidence on imaging techniques in giant cell arteritis (GCA) and Takayasu arteritis (TAK). This is a report on the performance of ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18-FDG-PET), and other emerging imaging techniques in diagnosis, outcome prediction, and monitoring of disease activity. Recent Findings Imaging techniques have gained an important role for diagnosis of large vessel vasculitides (LVV). As signs of vasculitis, US, MRI, and CT show a homogeneous arterial wall thickening, which is mostly concentric. PET displays increased FDG uptake in inflamed artery walls. US is recommended as the initial imaging modality in GCA. MRI and PET/CT may also detect vasculitis of temporal arteries. For TAK, MRI is recommended as the first imaging modality as it provides a good overview without radiation. Extracranial LVV can be confirmed by all four modalities. In addition, MRI and PET/CT provide consistent examination of the aorta and its branches. New techniques such as contrast-enhanced ultrasound, PET/MRI, and auxiliary methods such as “computer-assisted quantitative analysis” have emerged and need to be further validated. Summary Imaging has partly replaced histology for confirming LVV. Provided experience and adequate training, US, MRI, CT, or PET provide excellent diagnostic accuracy. Imaging results need to complement history and clinical examination. Ongoing studies are evaluating the role of imaging for monitoring and outcome measurement.
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Affiliation(s)
- Valentin Sebastian Schäfer
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany.
| | - Lei Jin
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
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Imfeld S, Aschwanden M, Rottenburger C, Schegk E, Berger CT, Staub D, Daikeler T. [18F]FDG positron emission tomography and ultrasound in the diagnosis of giant cell arteritis: congruent or complementary imaging methods? Rheumatology (Oxford) 2020; 59:772-778. [PMID: 31436837 DOI: 10.1093/rheumatology/kez362] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/15/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES [18F]Fluorodeoxyglucose (FDG)-PET/CT and US are both well established for diagnosing GCA. The present study investigates their accuracy and whether they provide overlapping or complementary information in a cohort of patients presenting with suspicion of GCA. METHODS We selected consecutive patients from our cohort of suspected GCA cases that underwent both extended vascular US and PET/CT for diagnostic work-up between December 2006 and August 2012. RESULTS A total of 102 patients were included. Diagnosis of GCA was confirmed in 68 patients and excluded in 34 patients (controls). Vasculitic changes in US were most often found in the temporal artery with 32 positive findings on each side, followed by the popliteal artery (10 right, 9 left) and the subclavian/axillary artery (7 right, 8 left). By contrast, PET/CT showed vasculitis most frequently in the vertebral (23 right, 33 left) and common carotid arteries (32 right, 24 left), followed by the subclavian arteries (16 right, 18 left), and the thoracic (17) and abdominal aorta (23). In 37/68 GCA patients PET/CT and US both revealed vasculitic findings, 11/68 had positive findings in US only and 14/68 in PET/CT only. Specificity of US was higher (one false-positive vs five false-positive in PET/CT). On a single segment level, only 20 of 136 positive segments were positive in both imaging modalities. CONCLUSION PET/CT measuring vessel wall metabolism and US vessel wall morphology showed a comparable diagnostic accuracy for GCA. However PET/CT and US were often discrepant within single vascular regions. Thus PET/CT and US should be considered as complementary methods, with a second imaging modality increasing the diagnostic yield by 16-20%.
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Affiliation(s)
| | | | | | - Elke Schegk
- Department of Rheumatology, Basel, Switzerland
| | - Christoph T Berger
- Departments of Biomedicine and Internal Medicine, Translational Immunology and Medical Outpatient Clinic, University Hospital Basel, Basel, Switzerland
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Johri AM, Nambi V, Naqvi TZ, Feinstein SB, Kim ESH, Park MM, Becher H, Sillesen H. Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33:917-933. [PMID: 32600741 DOI: 10.1016/j.echo.2020.04.021] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Atherosclerotic plaque detection by carotid ultrasound provides cardiovascular disease risk stratification. The advantages and disadvantages of two-dimensional (2D) and three-dimensional (3D) ultrasound methods for carotid arterial plaque quantification are reviewed. Advanced and emerging methods of carotid arterial plaque activity and composition analysis by ultrasound are considered. Recommendations for the standardization of focused 2D and 3D carotid arterial plaque ultrasound image acquisition and measurement for the purpose of cardiovascular disease stratification are formulated. Potential clinical application towards cardiovascular risk stratification of recommended focused carotid arterial plaque quantification approaches are summarized.
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Affiliation(s)
| | | | | | | | - Esther S H Kim
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret M Park
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
| | - Harald Becher
- University of Alberta Hospital, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Henrik Sillesen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Abstract
Purpose of Review Vasculitides are characterized by mostly autoimmunologically induced inflammatory processes of vascular structures. They have various clinical and radiologic appearances. Early diagnosis and reliable monitoring are indispensable for adequate therapy to prevent potentially serious complications. Imaging, in addition to laboratory tests and physical examination, constitutes a key component in assessing disease extent and activity. This review presents current standards and some typical findings in the context of imaging in vasculitis with particular attention to large vessel vasculitides. Recent Findings Recently, imaging has gained importance in the management of vasculitis, especially regarding large vessel vasculitides (LVV). Recently, EULAR (European League Against Rheumatism) has launched its recommendations concerning the diagnosis of LVVs. Imaging is recommended as the preferred complement to clinical examination. Color-coded duplex sonography is considered the first choice imaging test in suspected giant cell arteritis, and magnetic resonance imaging is considered the first choice in suspected Takayasu’s arteritis. Summary Due to diversity of clinical and radiologic presentations, diagnosis and therapy monitoring of vasculitides may constitute a challenge. As a result of ongoing technological progress, a variety of non-invasive imaging modalities now play an elemental role in the interdisciplinary management of vasculitic diseases.
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Affiliation(s)
- Konstanze Viktoria Guggenberger
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Wuerzburg, University of Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany.
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Wuerzburg, University of Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany.
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Ito S, Tahara N, Hirakata S, Kaieda S, Tahara A, Maeda-Ogata S, Bekki M, Sugiyama Y, Honda A, Igata S, Kuromatsu R, Nakashima O, Fukumoto Y. Signal intensity of superb micro-vascular imaging associates with the activity of vascular inflammation in Takayasu arteritis. J Nucl Cardiol 2020; 27:1063-1065. [PMID: 30834495 DOI: 10.1007/s12350-019-01665-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Shinichiro Ito
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan
- Ultrasound Diagnostic Center, Kurume University Hospital, Kurume, Japan
| | - Nobuhiro Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Saki Hirakata
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Shinjiro Kaieda
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Atsuko Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Shoko Maeda-Ogata
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Munehisa Bekki
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Yoichi Sugiyama
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Sachiyo Igata
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Ryoko Kuromatsu
- Ultrasound Diagnostic Center, Kurume University Hospital, Kurume, Japan
| | - Osamu Nakashima
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
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Chaolun LMD, Lingying MMD, Linjin HMD, Hong HMD, Lingdi JMD, Wenping WMD. Use of Contrast-Enhanced Ultrasound for Detecting the Disease Activity of the Carotid Artery in Takayasu Arteritis. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Svensson C, Eriksson P, Zachrisson H. Vascular ultrasound for monitoring of inflammatory activity in Takayasu arteritis. Clin Physiol Funct Imaging 2019; 40:37-45. [DOI: 10.1111/cpf.12601] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Christina Svensson
- Department of Clinical Physiology University Hospital Linköping Sweden
- Department of Medicine and Health Science Division of Clinical Physiology Linköping University Linköping Sweden
| | - Per Eriksson
- Rheumatology/Division of Neuro and Inflammation Sciences Department of Clinical and Experimental Medicine Division of Rheumatology Faculty of Health Sciences Linköping University Linköping Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology University Hospital Linköping Sweden
- Department of Medicine and Health Science Division of Clinical Physiology Linköping University Linköping Sweden
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Blockmans D, Luqmani R, Spaggiari L, Salvarani C. Magnetic resonance angiography versus 18F-fluorodeoxyglucose positron emission tomography in large vessel vasculitis. Autoimmun Rev 2019; 18:102405. [PMID: 31648043 DOI: 10.1016/j.autrev.2019.102405] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 06/13/2019] [Indexed: 12/30/2022]
Abstract
With advances in our understanding of the pathogenesis of large vessel vasculitides, we recognise the persistence of inflammation in large vessels, sometimes despite therapy to control clinical symptoms. Achieving an early diagnosis and establishing the extent of disease are important steps in improving our management of these diseases. Imaging is playing an increasing role in the assessment of these patients from diagnosis to prognosis. We review the current and potential role of two important and potentially complementary imaging techniques of magnetic resonance angiography and 18F-fluorodeoxyglucose positron emission tomography in the evaluation of patients with giant cell arteritis and Takayasu arteritis.
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Affiliation(s)
- Daniel Blockmans
- General Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK.
| | - Lucia Spaggiari
- Department of Radiology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Rheumatology Division, Universita' di Modena e Reggio Emilia and Azienda USL-IRCCS di Reggio Emilia, Italy
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Kalashnikova LA, Dobrynina LA, Legenko MS. [Primary central nervous system vasculitis]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:113-123. [PMID: 31626179 DOI: 10.17116/jnevro2019119081113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Primary vasculitis (angiitis) of the central nervous system (PACNS) is a rare disease targeting the vessels of the brain, spinal cord and leptomeninges without systemic involvement. The etiology is not clear enough. The authors review clinical, laboratory and radiological features of PACNS. Clinical manifestations are variable and depend on the caliber of affected vessels. The main clinical manifestations of small sized vessel vasculitis include encephalopathy (cognitive disorders, epileptic seizures), headache and transient cerebral ischemia. The main clinical presentation of vasculitis of medium/large cerebral arteries is ischemic strokes, which usually develop in different vascular territories. CSF findings in the majority of patients show modest lymphocytic pleocytosis, elevated protein level and occasionally the presence of oligoclonal bands. MRI data are not specific and include infarcts, hyperintensity (FLAIR) and sometimes tumor-like lesions. The gold standard for the verification of PACNS affected small-sized arteries is brain and leptomeningeal biopsy. Cerebral angiography allows the verification of vasculitis of medium and large cerebral arteries revealing segmental narrowings (beading). High resolution black blood MRI before and after contrast injection may visualize intracranial vessel wall contrast enhancement - the sign of inflammation in intracranial arteries. Treatment of PACNS includes corticosteroids and cyclophosphamide. In the case of patient intolerance, rituximab and blockers of tumor necrosis factor may be used.
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Affiliation(s)
| | | | - M S Legenko
- Research Center of Neurology, Moscow, Russia
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Brkic A, Terslev L, Møller Døhn U, Torp‐Pedersen S, Schmidt WA, Diamantopoulos AP. Clinical Applicability of Ultrasound in Systemic Large Vessel Vasculitides. Arthritis Rheumatol 2019; 71:1780-1787. [DOI: 10.1002/art.41039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 07/09/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Alen Brkic
- Stavanger University Hospital Stavanger Norway
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Wang Y, Wang YH, Tian XP, Wang HY, Li J, Ge ZT, Yang YJ, Cai S, Zeng XF, Li JC. Contrast-enhanced ultrasound for evaluating arteritis activity in Takayasu arteritis patients. Clin Rheumatol 2019; 39:1229-1235. [DOI: 10.1007/s10067-019-04698-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/07/2019] [Accepted: 07/15/2019] [Indexed: 11/29/2022]
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Li Z, Zheng Z, Ding J, Li X, Zhao Y, Kang F, Li Y, Pang L, Du W, Wu Z, Zhu P. Contrast-enhanced Ultrasonography for Monitoring Arterial Inflammation in Takayasu Arteritis. J Rheumatol 2019; 46:616-622. [PMID: 30824642 DOI: 10.3899/jrheum.180701] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the utility of contrast-enhanced ultrasound (CEUS) compared with 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in assessing vessel inflammation of Takayasu arteritis (TA). METHODS This is a retrospective analysis of 71 patients with TA who had undergone carotid CEUS. Twenty-two of 71 patients underwent FDG-PET after CEUS. Clinical disease activity was assessed by Kerr criteria and the Indian Takayasu Clinical Activity Score 2010 (ITAS2010). We investigated the correlation between carotid vascularization on CEUS and clinical data. The consistency of carotid CEUS and PET data has been analyzed for TA disease activity. RESULTS There was a statistically significant correlation between the results of CEUS and ITAS2010 (p = 0.004) or Kerr criteria (p < 0.001). According to ITAS2010, thirty-four of 71 patients with TA were clinically inactive. Assessment of 34 TA patients with clinically inactive disease yielded 11 CEUS scans that showed active lesions (visual grade ≥ 2) in the left or right carotid artery. In 22 cases that underwent CEUS and FDG-PET, 12 were active and 10 were inactive on the basis of ITAS2010. Moreover, bilateral carotid CEUS vascularization score positively correlated with vascular FDG uptake in these patients with TA (p = 0.004). When vascular inflammation was defined as FDG uptake with visual grade ≥ 2, carotid CEUS showed sensitivity of 100% and specificity of 80%. CONCLUSION For TA patients with clinically inactive disease, CEUS could help clinicians to identify active lesions in the carotid vascular region. Carotid CEUS may be a rapid and cost-effective imaging tool in the followup of patients with TA.
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Affiliation(s)
- ZhiQin Li
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - ZhaoHui Zheng
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Jin Ding
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - XiaoFeng Li
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - YongFeng Zhao
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Fei Kang
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Ying Li
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - LinXuan Pang
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - WangLei Du
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - ZhenBiao Wu
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work
| | - Ping Zhu
- From the Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China. .,Z.Q. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.H. Zheng, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; J. Ding, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; X.F. Li, MS, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University; Y.F. Zhao, MS, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University; F. Kang, MD, PhD, Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University; Y. Li, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; L.X. Pang, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; W.L. Du, MS, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; Z.B. Wu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University; P. Zhu, MD, PhD, Department of Clinical Immunology, Institute of Rheumatism and Immunity, PLA, Xijing Hospital, Fourth Military Medical University. ZhiQin Li and ZhaoHui Zheng contributed equally to this work.
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Podgorska D, Podgorski R, Aebisher D, Dabrowski P. Takayasu arteritis - epidemiology, pathogenesis, diagnosis and treatment. J Appl Biomed 2019; 17:20. [PMID: 34907753 DOI: 10.32725/jab.2018.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/05/2022] Open
Abstract
Takayasu disease belongs to the group of autoimmune vasculitis which most often affects the aorta and its branches. It is rare, and it mainly affects young women. Recent epidemiologic studies suggest that Takayasu arteritis is being increasingly recognized in Europe. The first symptoms are non-specific and an early diagnosis is difficult and requires clinical awareness and suspicion. Patients with Takayasu arteritis often present increased inflammatory markers, including C-reactive protein and erythrocyte sedimentation rate, but systemic inflammatory response does not always show a positive correlation with inflammatory activity in the vessel wall. Therefore, imaging studies play a principal role in diagnosis and control of the disease. Glucocorticoids remain the most effective and serve as a cornerstone first line treatment. Immunosuppressive drugs play an important role as well, and biological therapy is increasingly being included in the treatment. This article describes the epidemiology, pathophysiology, diagnostics and treatment of this rare disease, so as to alert clinicians because disease left untreated can lead to narrowing and even closure of vital blood vessels. The most common Takayasu arteritis complications include pulmonary thrombosis, aortic regurgitation, congestive heart failure, cerebrovascular events, vision degeneration or blindness, and hearing problems.
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Affiliation(s)
- Dominika Podgorska
- Clinical Provincial Hospital No. 2, Department of Rheumatology, Rzeszow, Poland
| | - Rafal Podgorski
- University of Rzeszow, Centre for Medical and Natural Sciences Research and Innovation, Rzeszow, Poland.,University of Rzeszow, Faculty of Medicine, Department of Biochemistry, Rzeszow, Poland
| | - David Aebisher
- University of Rzeszow, Faculty of Medicine, Department of Human Immunology, Rzeszow, Poland
| | - Piotr Dabrowski
- Clinical Provincial Hospital No. 2, Department of Rheumatology, Rzeszow, Poland
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The Role of Vascular Imaging to Advance Clinical Care and Research in Large-Vessel Vasculitis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019; 5:20-35. [PMID: 31598465 DOI: 10.1007/s40674-019-00114-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose of the Review The two main forms of large-vessel vasculitis (LVV) are giant cell arteritis (GCA) and Takayasu's arteritis (TAK). Vascular imaging can characterize disease activity and disease extent in LVV. This review critically analyzes the clinical utility of vascular imaging in LVV and highlights how imaging may be incorporated into the management and study of these conditions. Recent Findings There are multiple imaging modalities available to assess LVV including ultrasonography, CT angiography (CTA), magnetic resonance angiography (MRA), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). As these techniques are refined, imaging may be increasingly useful to evaluate the cranial arteries and the aorta and its primary branches. In addition, vascular imaging may be useful to monitor disease activity and may have prognostic value to predict future clinical events. Summary There are strengths and weaknesses associated with vascular imaging that should be considered when evaluating patients with LVV. Vascular imaging will likely play an increasingly important role in the clinical management of patients and the conduct of research in LVV and may ultimately be incorporated as outcome measures in clinical trials in these conditions.
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Ma LY, Li CL, Ma LL, Cui XM, Dai XM, Sun Y, Chen HY, Huang BJ, Jiang LD. Value of contrast-enhanced ultrasonography of the carotid artery for evaluating disease activity in Takayasu arteritis. Arthritis Res Ther 2019; 21:24. [PMID: 30651132 PMCID: PMC6335720 DOI: 10.1186/s13075-019-1813-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
AIMS To assess the value of contrast-enhanced ultrasonography (CEUS) for monitoring disease activity of Takayasu arteritis (TA). METHODS TA patients were recruited in a Chinese TA clinical center from January 2016 to September 2017. The physician global assessment was used as the referential standard for disease activity. Clinical data, acute phase reactants, and CEUS scans were simultaneously recorded at baseline and after a 3-month therapy. RESULTS A total of 84 TA patients were enrolled, and 47 (55.95%) cases were active at baseline. Macaroni sign and entire artery involvement were characteristic findings of CEUS in TA. The average vascular full thickness of the carotid artery in active TA patients was significantly higher than that in inactive patients (2.36 ± 0.86 vs. 1.79 ± 0.49 mm; p = 0.001). Severe neovascularization (grade 2) was observed in 29 active cases (61.70%) and in 9 inactive cases (24.32%) (p = 0.001). Receiver operating characteristic analysis showed that the combination of CEUS parameters (cutoff of thickness was 1.75 mm or neovascularization grade 2) and erythrocyte sedimentation rate (ESR) (cutoff of 20 mm/H) could help differentiate between active and inactive TA patients with a sensitivity and specificity of 81.1% and 81.5%, respectively. Youdon's index was 0.626. Furthermore, our study found that patients with decreased ESR and C-reactive protein (CRP) still had a progression of vascular wall inflammation at 3 months of follow-up. CONCLUSIONS The evaluation of vascular inflammation by CEUS is more sensitive than acute phase reactants. Neovascularization can still be observed in the vascular lesion sites of those who have reached clinical remission after treatment. Thus, CEUS can be used as an alternative method to assess disease activity for TA patients.
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Affiliation(s)
- Ling-Ying Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Chao-Lun Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Li-Li Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Xiao-Meng Cui
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Xiao-Min Dai
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Ying Sun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Hui-Yong Chen
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Bei-Jian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Lin-Di Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China. .,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, People's Republic of China.
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Schramm N, Ingenhoff J, Dechant C, Treitl KM, Treitl M, Proft F, Schulze-Koops H, Hoffmann U, Bartenstein P, Rominger A, Czihal M. Diagnostic accuracy of positron emission tomography for assessment of disease activity in large vessel vasculitis. Int J Rheum Dis 2018; 22:1371-1377. [PMID: 30565885 DOI: 10.1111/1756-185x.13440] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/23/2018] [Accepted: 10/18/2018] [Indexed: 01/18/2023]
Abstract
AIM To determine the diagnostic yield of 18 F-fluorodeoxyglucose positron emission tomography (PET) in disease activity assessment of large vessel vasculitides (LVV). METHODS Patients with LVV who had undergone PET (between 2004 and June 2010) or PET co-registered with computed tomography (PET/CT; since June 2010) were identified. Clinical disease activity was assessed using established scoring systems. PET images were reviewed by two blinded nuclear medicine physicians. Uptake of the aortic wall was compared to the liver uptake utilizing a visual 4-point score, with a vessel wall uptake similar or higher than liver uptake considered as active disease. Various target-to-background ratios were calculated. Receiver operator characteristics analysis was applied to determine the diagnostic accuracy of PET for detecting clinically active disease. Interobserver agreement of visual readings was measured with Cohen´s kappa. RESULTS Eighty examinations in 62 patients were analyzed, with a mean time between diagnosis and PET of 106 ± 171 weeks. Fifty-seven cases were finally classified as clinically active and 23 cases as clinically inactive. With a cut-off value of 1.3, the aorta-to-liver ratio yielded a sensitivity and specificity of 84.2% and 82.6% (area under the curve 0.9). Overall, sensitivity and specificity of visual analysis were 68.4% and 91.3%, but sensitivity decreased to 54% in patients treated for more than 3 months. Interobserver agreement of visual rating was excellent (κ: 0.93). CONCLUSION Positron emission tomography is specific and reliable in disease activity assessment of LVV, but lacks sensitivity for detecting active disease in patients under long-term immunosuppressive treatment.
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Affiliation(s)
- Nicolai Schramm
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Janina Ingenhoff
- Division of Vascular Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Claudia Dechant
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Karla-Maria Treitl
- Department of Radiology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Marcus Treitl
- Department of Radiology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Fabian Proft
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Czihal
- Division of Vascular Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Schmidt WA, Blockmans D. Investigations in systemic vasculitis - The role of imaging. Best Pract Res Clin Rheumatol 2018; 32:63-82. [PMID: 30526899 DOI: 10.1016/j.berh.2018.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 12/18/2022]
Abstract
Imaging plays an increasing role for confirming a suspected diagnosis of giant cell arteritis (GCA) or Takayasu arteritis (TAK). Ultrasound, magnetic resonance imaging (MRI), and computed tomography demonstrate a homogeneous, most commonly concentric, arterial wall thickening. 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) displays increased FDG uptake of inflamed artery walls delineating increased metabolism. Ultrasound and MRI are recommended to be the initial imaging modalities in cranial GCA and TAK, respectively. Extracranial disease can be confirmed by all four modalities, particularly by PET in case of inflammation of unknown origin. If the diagnosis remains uncertain, additional investigations including biopsy and/or additional imaging are recommended. Imaging should be performed by a trained specialist using appropriate operational procedures and settings with appropriate equipment. Further research is necessary on the role of imaging for disease monitoring. This review will discuss advantages and disadvantages of imaging modalities in the diagnosis of vasculitis.
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Affiliation(s)
- Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Lindenberger Weg 19, 13125, Berlin, Germany.
| | - Daniel Blockmans
- University Hospital Gasthuisberg, Herestraat 49, B3000, Leuven, Belgium.
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Misra DP, Naidu GSRSNK, Agarwal V, Sharma A. Vasculitis research: Current trends and future perspectives. Int J Rheum Dis 2018; 22 Suppl 1:10-20. [PMID: 30168260 DOI: 10.1111/1756-185x.13370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/03/2018] [Accepted: 07/25/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Durga P. Misra
- Department of Clinical Immunology; Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS); Lucknow India
| | - Godasi S. R. S. N. K. Naidu
- Department of Internal Medicine; Clinical Immunology and Rheumatology Services; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Vikas Agarwal
- Department of Clinical Immunology; Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS); Lucknow India
| | - Aman Sharma
- Department of Internal Medicine; Clinical Immunology and Rheumatology Services; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
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Schmidt WA. Ultrasound in the diagnosis and management of giant cell arteritis. Rheumatology (Oxford) 2018; 57:ii22-ii31. [PMID: 29982780 DOI: 10.1093/rheumatology/kex461] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 11/12/2022] Open
Abstract
US has become an important diagnostic tool for musculoskeletal diseases. Because of its wide availability in rheumatology practice, US has also been applied in other rheumatic diseases such as GCA. In acute GCA, US displays a non-compressible, hypoechoic, most commonly concentric arterial wall thickening. Temporal and axillary arteries should be examined in patients with suspected GCA and PMR. Additionally, almost all other large arteries, with the exception of the thoracic aorta, can be easily delineated by US. Many studies and several meta-analyses have been conducted to evaluate the diagnostic performance of US. US is more sensitive than temporal artery biopsy (TAB) because TAB evaluates only a limited anatomical region in a systemic disease. Most US studies arrive at specificities between 90 and 100% compared with the final clinical diagnosis. Reliability for reading US images and videos is excellent and comparable to reliability for reading TAB specimens. The advantage of US over other imaging techniques in GCA is its availability, safety and tolerability and its high resolution of 0.1 mm. Rheumatology departments are increasingly establishing fast-track clinics. Physicians can refer patients with suspected GCA within 24 h. Patients receive clinical and US examination by experienced specialists, establishing a clear diagnosis either before TAB or without the need for TAB. The introduction of fast-track clinics has led to a significant reduction of permanent vision loss. Furthermore, a process that primarily includes US is significantly more cost-effective than TAB.
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Affiliation(s)
- Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
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Abstract
PURPOSE OF REVIEW Biomarkers are considered to be helpful in diagnosing, monitoring, predicting treatment response, and prognosis in clinical practice and as outcomes in clinical trials. In this article, we review the recent literature on new biomarkers and the expanding use of older ones in vasculitic conditions. RECENT FINDINGS In antineutrophil cytoplasmic antibody-associated vasculitis patients antineutrophil cytoplasmic antibody type may be useful as a predictor of relapse and response to rituximab. Moreover, serial measurements of proteinase-3 titer may help to predict relapse. Urinary soluble CD163 levels are promising for identifying active renal vasculitis. Imaging modalities such as positron emission tomography, computerized angiography tomography, and temporal artery ultrasound maintain their role in diagnosis and disease assessment in large vessel vasculitis. Fecal calprotectin is a useful marker of active gastrointestinal involvement in Behçet's syndrome. SUMMARY The publications reviewed here potentially may help to move the field of biomarkers in vasculitis management. However, more work toward understanding the underlying pathophysiology and effects of an intervention on the disease process are needed before true biomarkers can be realized. Further studies with appropriate control groups, using good definitions for disease states such as activity and remission are needed to guide our use of these markers correctly in the management of our patients.
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Monti S, Floris A, Ponte C, Schmidt WA, Diamantopoulos AP, Pereira C, Piper J, Luqmani R. The use of ultrasound to assess giant cell arteritis: review of the current evidence and practical guide for the rheumatologist. Rheumatology (Oxford) 2018; 57:227-235. [PMID: 28460064 DOI: 10.1093/rheumatology/kex173] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Indexed: 11/14/2022] Open
Abstract
Colour duplex sonography (CDS) of temporal arteries and large vessels is an emerging diagnostic tool for GCA. CDS can detect wall oedema, known as a halo, throughout the length of the vessel and shows higher sensitivity compared with biopsy. Specificity reaches 100% in case of bilateral halos. A positive compression sign has been demonstrated to be a robust marker with excellent inter-observer agreement. The assessment of other large vessels, particularly the axillary arteries, is recognized to further increase the sensitivity and to reliably represent extra-cranial involvement in other areas. Nevertheless, CDS use is still not widespread in routine clinical practice and requires skilled sonographers. Moreover, its role in the follow-up of patients still needs to be defined. The aim of this review is to provide the current evidence and technical parameters to support the rheumatologist in the CDS evaluation of patients with suspected GCA.
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Affiliation(s)
- Sara Monti
- Rheumatology Department, NDORMS, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.,Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Alberto Floris
- Rheumatology Unit, University Clinic and AOU of Cagliari, Cagliari, Italy
| | - Cristina Ponte
- Department of Rheumatology, Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | | | - Claudio Pereira
- Rheumatology Department, NDORMS, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Jennifer Piper
- Rheumatology Department, NDORMS, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Raashid Luqmani
- Rheumatology Department, NDORMS, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
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Sun Y, Huang Q, Jiang L. Radiology and biomarkers in assessing disease activity in Takayasu arteritis. Int J Rheum Dis 2018; 22 Suppl 1:53-59. [PMID: 29624875 DOI: 10.1111/1756-185x.13286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Ying Sun
- Department of Rheumatology; Zhongshan Hospital; Fudan University; Shanghai China
| | - Qingrong Huang
- Department of Rheumatology; Zhongshan Hospital; Fudan University; Shanghai China
| | - Lindi Jiang
- Department of Rheumatology; Zhongshan Hospital; Fudan University; Shanghai China
- Center of Evidence-based Medicine; Fudan University; Shanghai China
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Czihal M, Lottspeich C, Schröttle A, Treitl KM, Treitl M, Leipe J, Schulze-Koops H, Hoffmann U, Dechant C. Relapses in three patients with Takayasu arteritis under tocilizumab treatment detected by contrast enhanced ultrasound. VASA 2018; 47:149-152. [DOI: 10.1024/0301-1526/a000679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Abstract. Takayasu arteritis (TA) is a rare large vessel vasculitis, affecting the aorta and its major branches, typically in young women. In this case report, we present three cases of young women of Caucasian descent who experienced relapses while under treatment with the monoclonal humanized antibody to the interleukin 6 receptor, tocilizumab. Active vasculitic lesions of the supraaortic (common carotid and axillary) arteries were detected and characterized via high resolution contrast enhanced ultrasound. Based on these cases, we discuss the potential role of contrast enhanced ultrasound in the diagnosis and follow-up of TA as well as the current data on the efficacy of tocilizumab in the treatment of TA.
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Affiliation(s)
- Michael Czihal
- Division of Vascular Medicine, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Christian Lottspeich
- Division of Vascular Medicine, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Angelika Schröttle
- Division of Vascular Medicine, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Karla Maria Treitl
- Department of Radiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Marcus Treitl
- Department of Radiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Jan Leipe
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Claudia Dechant
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
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Tocilizumab and refractory Takayasu disease: Four case reports and systematic review. Autoimmun Rev 2018; 17:353-360. [PMID: 29427826 DOI: 10.1016/j.autrev.2017.11.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Relapses upon corticosteroids tapering and immunosuppressive agents are frequent in Takayasu arteritis (TA). Interleukin-6 is highly involved in physiopathology of TA. Many reports showed efficacy of tocilizumab (TCZ) in refractory TA cases. We report four cases and an updated literature review on the TCZ efficacy and safety in patients with TA. METHODS Patients with TA defined by ACR 1990 criteria were included. Clinical, biological and imaging data were retrospectively reported. Disease activity was analyzed before TCZ and during the follow-up. Medline database was searched for systematic literature review. RESULTS One hundred and five patients (median age 28years [22-38]) were included, mostly refractory cases (76 patients, 72%). Median TCZ duration was 12months [6-20]. Among 105 patients, 90 patients (85.7%) had an initial clinical response within three months [3-6] and 43/66 patients (65.2%) had a radiological improvement. Only seven patients (9%) showed relapse on therapy. Corticosteroid dose reduction was obtained in 75/83 patients (90.4%). Relapse after TCZ discontinuation was observed in six patients (46%), with a median time of five months [2-9]. Twenty-four side-effects were noted in 18 patients (18%), with TCZ interruption in seven cases (7%): 10 infections, five cytopenia, six hepatitis, one pancreatitis, one cutaneous rash and one breast cancer. CONCLUSIONS This review confirms that TCZ is safe and effective in refractory cases of TA and TCZ is a corticosteroid-sparing therapy in patients with or without previous TNFα blockers therapy. However relapses after TCZ discontinuation are frequent.
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Kaspar M, Imfeld S, Partovi S, Aschwanden M, Baldi T, Dikkes A, Vogt DR, Tsakiris DA, Staub D. Perivascular Perfusion on Contrast-Enhanced Ultrasound (CEUS) Is Associated with Inflammation in Patients with Acute Deep Vein Thrombosis. Thromb Haemost 2017; 117:2146-2155. [PMID: 28933797 DOI: 10.1160/th17-05-0332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Inflammatory processes of the venous wall in acute deep vein thrombosis (DVT) play a role in thrombus formation and resolution. However, direct evaluation of the perivascular inflammation is currently not feasible. Objective To assess perivascular perfusion in acute proximal DVT using contrast-enhanced ultrasound (CEUS) reflecting perivenous inflammation and its association with systemic inflammatory markers in a single-centre, prospective observational study. Patients/Methods Twenty patients with proximal DVT underwent CEUS imaging in the thrombosed and contralateral popliteal vein at baseline and after 2 weeks and 3 months. Perfusion was quantified by measuring peak enhancement (PE) and wash-in rate (WiR) in a perivenous region after bolus injection of the contrast agent. High-sensitive C-reactive protein (hsCRP) and interleukin-6 (IL-6) were determined at the time of each CEUS imaging. Results PE and WiR were significantly higher in the thrombosed compared with the unaffected leg at baseline (1,007 vs. 34 au and 103 vs. 4 au/s) and 2-week follow-up (903 vs. 35 au and 70 vs. 4 au/s). Compared with baseline, PE and WiR in the thrombosed leg significantly decreased to 217 au and 18 au/s at 3-month follow-up.At baseline, hsCRP and IL-6 were elevated at 20.1 mg/mL and 8.2 pg/mL and decreased significantly to 2.8 mg/mL and 2.6 pg/mL at 2-week follow-up, remaining low after 3 months. There was a weak association between the level of inflammatory markers and the CEUS parameters at baseline on the thrombosed leg. Conclusion Elevated perivascular perfusion assessed by CEUS imaging is associated with the inflammatory response in acute DVT.
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Affiliation(s)
- Mathias Kaspar
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Stephan Imfeld
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
| | - Markus Aschwanden
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Thomas Baldi
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Alexander Dikkes
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Deborah R Vogt
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland
| | - Dimitrios A Tsakiris
- Department of Diagnostic Haematology, University Hospital Basel, University of Basel, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
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Abstract
OPINION STATEMENT Takayasu arteritis, fibromuscular dysplasia (FMD), spontaneous arterial dissection, Raynaud's phenomenon, and chilblains are vascular conditions that are associated with an increased predisposition in women and are often underdiagnosed. Takayasu arteritis has an incidence rate of 2.6 cases per million individuals per year in the USA and predominantly affects women of childbearing age. HLA-B5 genetic locus is linked with Takayasu arteritis susceptibility. Methods to determine active disease are limiting; currently utilized clinical and imaging findings and laboratory tests are of limited value for this purpose. Pregnancy poses risks for maternal and fetal complications, and these patients need additional monitoring and care before and after conception. Controlling hypertension and immunosuppression using steroids, biological and non-biological immunosuppressants, are key components of managing patients with this arteritis. FMD commonly affects middle-aged, white females. Its true prevalence is unknown. Renal and cerebrovascular beds are the most frequently involved vascular beds. Its clinical presentation varies from no symptoms to catastrophic events. Controlling vascular risk factors, periodic surveillance, and revascularization when indicated are important factors in FMD management. Spontaneous arterial dissections are less common, but are an important cause of morbidity and mortality in specific populations. Cervicocephalic dissection causes 10-20% of the strokes in young adults, and coronary artery dissection is the culprit in almost one fourth of young women presenting with acute myocardial infarction. Early diagnosis is key to improving prognosis in these patients, as the majority of patients have spontaneous resolution of the dissection with conservative management alone. Increased clinician awareness of the presentation features and angiographic findings are imperative for early diagnosis. Raynaud's phenomenon and chilblains are cold- or stress-induced cutaneous lesions, commonly involving distal extremities. Secondary causes such as connective tissue diseases and malignancies must be thoroughly excluded during evaluation of these conditions. Cold avoidance, systemic and local warming, and oral vasodilator therapy are the mainstays of therapy.
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Giant cell arteritis and polymyalgia rheumatica: current challenges and opportunities. Nat Rev Rheumatol 2017; 13:578-592. [PMID: 28905861 DOI: 10.1038/nrrheum.2017.142] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The fields of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) have advanced rapidly, resulting in a new understanding of these diseases. Fast-track strategies and improved awareness programmes that prevent irreversible sight loss through early diagnosis and treatment are a notable advance. Ultrasonography and other imaging techniques have been introduced into routine clinical practice and there have been promising reports on the efficacy of biologic agents, particularly IL-6 antagonists such as tocilizumab, in treating these conditions. Along with these developments, which should improve outcomes in patients with GCA and PMR, new questions and unmet needs have emerged; future research should address which pathogenetic mechanisms contribute to the different phases and clinical phenotypes of GCA, what role imaging has in the early diagnosis and monitoring of GCA and PMR, and in which patients and phases of these diseases novel biologic drugs should be used. This article discusses the implications of recent developments in our understanding of GCA and PMR, as well as the unmet needs concerning epidemiology, pathogenesis, imaging and treatment of these diseases.
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de Boysson H, Dumont A, Liozon E, Lambert M, Boutemy J, Maigné G, Martin Silva N, Sultan A, Ly KH, Aide N, Manrique A, Bienvenu B, Aouba A. Giant-cell arteritis: concordance study between aortic CT angiography and FDG-PET/CT in detection of large-vessel involvement. Eur J Nucl Med Mol Imaging 2017; 44:2274-2279. [PMID: 28736805 DOI: 10.1007/s00259-017-3774-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/30/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of our study was to assess the concordance of aortic CT angiography (CTA) and FDG-PET/CT in the detection of large-vessel involvement at diagnosis in patients with giant-cell arteritis (GCA). METHODS We created a multicenter cohort of patients with GCA diagnosed between 2010 and 2015, and who underwent both FDG-PET/CT and aortic CTA before or in the first ten days following treatment introduction. Eight vascular segments were studied on each procedure. We calculated concordance between both imaging techniques in a per-patient and a per-segment analysis, using Cohen's kappa concordance index. RESULTS We included 28 patients (21/7 women/men, median age 67 [56-82]). Nineteen patients had large-vessel involvement on PET/CT and 18 of these patients also presented positive findings on CTA. In a per-segment analysis, a median of 5 [1-7] and 3 [1-6] vascular territories were involved on positive PET/CT and CTA, respectively (p = 0.03). In qualitative analysis, i.e., positivity of the procedure suggesting a large-vessel involvement, the concordance rate between both procedures was 0.85 [0.64-1]. In quantitative analysis, i.e., per-segment analysis in both procedures, the global concordance rate was 0.64 [0.54-0.75]. Using FDG-PET/CT as a reference, CTA showed excellent sensitivity (95%) and specificity (100%) in a per-patient analysis. In a per-segment analysis, sensitivity and specificity were 61% and 97.9%, respectively. CONCLUSIONS CTA and FDG-PET/CT were both able to detect large-vessel involvement in GCA with comparable results in a per-patient analysis. However, PET/CT showed higher performance in a per-segment analysis, especially in the detection of inflammation of the aorta's branches.
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Affiliation(s)
- Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France.
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Eric Liozon
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - Marc Lambert
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Gwénola Maigné
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Nicolas Martin Silva
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Audrey Sultan
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Kim Heang Ly
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - Nicolas Aide
- Department of Nuclear Medicine, Caen University Hospital, Caen, France.,INSERM U1086 "ANTICIPE", François Baclesse Cancer Centre, Caen, France
| | - Alain Manrique
- Department of Nuclear Medicine, Caen University Hospital, Caen, France.,Normandy University, EA4650, Caen, France
| | - Boris Bienvenu
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
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Dikkes A, Aschwanden M, Imfeld S, Glatz K, Messerli J, Staub D, Daikeler T. Takayasu arteritis: active or not, that’s the question. Rheumatology (Oxford) 2017; 56:1818-1819. [DOI: 10.1093/rheumatology/kex213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Various imaging modalities, including color duplex ultrasonography, CT angiography, magnetic resonance angiography, and PET, are emerging as important aids to the diagnosis, staging, evaluation of disease activity and response to treatment in systemic vasculitis. Although large-vessel vasculitis is the main target of imaging, refinement and increasing accuracy of imaging modalities are also providing useful information in the evaluation of medium-vessel and small-vessel vasculitis.
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