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Skoog J, Svensson C, Eriksson P, Sjöwall C, Zachrisson H. High-frequency ultrasound with superb microvascular imaging: a potential tool for ultrasound assessment in patients with giant cell arteritis. Front Med (Lausanne) 2024; 11:1431385. [PMID: 39050531 PMCID: PMC11266178 DOI: 10.3389/fmed.2024.1431385] [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: 05/11/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024] Open
Abstract
Objective The objective of this study was 2-fold: first, to evaluate whether superb microvascular imaging (SMI) could be used to visualize neovascularization in temporal arteries, and, second, to evaluate the diagnostic performance of high frequency ultrasound with SMI using an extended protocol in patients with suspected giant cell arteritis (GCA). Methods This retrospective study comprised 120 patients consecutively examined with an extended CDU protocol (temporal, facial, axillary, subclavian, brachiocephalic, and carotid arteries) between 2020 and 2022. Of all patients, 107 had no previous GCA diagnosis and 13 had a previous GCA diagnosis. SMI was used to evaluate neovascularization in the temporal arteries. Arteritis were characterized as low- or medium-echogenic, homogeneous wall thickening, with or without a positive compression sign in the temporal arteries. The Halo count, i.e., the number of temporal and axillary artery segments with signs of arteritis, was evaluated. The reference was clinically diagnosed GCA confirmed after ≥6-month follow-up. Results Of the eligible 107 patients with new suspected GCA, 33 (31%) received a clinical GCA diagnosis. Neovascularization was detected in 14 patients (43%). Patients with neovascularization displayed a higher halo count [median 6 (25th-75th percentile 4.75-7) vs. 3 (2-4-4), p = 0.005]. CDU of only the temporal arteries showed sensitivity and specificity (95% confidence intervals) of 94% (80-100%) and 100% (95-100%), respectively. The addition of extra-cranial arteries increased the sensitivity to 100%. Of the 13 patients investigated for suspected relapse, three had a clinically confirmed relapse. One of them displayed neovascularization together with other signs of inflammation. Conclusions We show for the first time that inflammatory neovascularization of the temporal arteries can be detected by SMI. Neovascularization is associated with a more-widespread cranial disease. The value of neovascularization should be further investigated, especially for the detection of GCA relapse.
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Affiliation(s)
- Johan Skoog
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Christina Svensson
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Per Eriksson
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden
| | - Christopher Sjöwall
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Seskute G, Jasionyte G, Rugiene R, Butrimiene I. The Use of Superb Microvascular Imaging in Evaluating Rheumatic Diseases: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1641. [PMID: 37763760 PMCID: PMC10537482 DOI: 10.3390/medicina59091641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Superb microvascular imaging is an advanced Doppler algorithm that seems to be useful in detecting low-velocity blood flow without using a contrast agent. Increasing evidence suggests that SMI is a more sensitive tool than conventional Doppler techniques for evaluating rheumatic diseases, especially inflammatory arthritis. We aimed to assess the use of SMI in evaluating joints and extraarticular structures. Materials and Methods: Two reviewers independently reviewed the literature to provide a global overview of the possibilities of SMI in rheumatology. Original English-language articles published between February 2014 and November 2022 were identified through database (PubMed, Medline, Ebsco, the Cochrane Library, and ScienceDirect) searching, and analysed to summarise existing evidence according to PRISMA methodology. Inclusion criteria covered original research articles reporting applications of SMI on rheumatic diseases and musculoskeletal disorders secondary to rheumatic conditions. Qualitative data synthesis was performed. Results: A total of 18 articles were included. No systematic reviews fulfilled our inclusion criteria. Most studies focused on characterising the synovial vascularity of rheumatoid arthritis. There have been several attempts to demonstrate SMI's value for evaluating extra-articular soft tissues (fat pads or salivary glands) and large-diameter vessels. The quantitative importance of SMI vascular indices could become a useful non-invasive diagnostic marker. Studies on therapeutic applications are still scarce, and the majority of studies have gaps in reporting the methodology (ultrasound performance technique and settings) of the research. Conclusions: SMI has proved to be useful in characterising low-flow vascularity, and growing evidence indicates that SMI is a non-invasive and lower-cost tool for prognostic assessment, especially in inflammatory arthritis. Preliminary findings also suggest potential interest in evaluating the effect of treatment.
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Affiliation(s)
- Goda Seskute
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
| | - Gabija Jasionyte
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
| | - Rita Rugiene
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
- Department of Experimental, Preventive and Clinical Medicine, State Research Institute Centre for Innovative Medicine, LT-08406 Vilnius, Lithuania
| | - Irena Butrimiene
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
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Liu FJ, Ci WP, Cheng Y. Clinical study of carotid superb microvascular imaging in evaluating the activity of Takayasu's arteritis. Front Cardiovasc Med 2023; 10:1051862. [PMID: 36950292 PMCID: PMC10025289 DOI: 10.3389/fcvm.2023.1051862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/16/2023] [Indexed: 03/08/2023] Open
Abstract
Objective The goal of this study is to use superb microvascular imaging (SMI) to observe neovascularization in the carotid vessel wall to identify potential Takayasu's arteritis (TAK) inflammation markers. Methods Bilateral carotid arteries from 96 patients with TAK were imaged by a Doppler ultrasound and SMI. The one-way analysis of variance (ANOVA) was used to document significant differences between the activity and inactivity stages of TAK and the factors closely related to its activity in the binary logistics regression equation. Clinical and laboratory data included age, gender, duration of disease, treatment history, NIH score, erythrocyte sedimentation rate (ESR), and high-sensitivity C-reactive protein. Imaging data included the arterial wall thickness, degree of lesion, SMI grade, and arterial aneurysm formation. Results There were 45 patients in the active TAK stage and 51 in the inactive stage. The one-way ANOVA showed significant differences in SMI (p = 0.001) and ESR (p = 0.022) between the active and inactive groups. The binary logistics regression analysis showed that SMI was an independent risk factor for TAK activity (B = -1.505, S.E = 0.340, Wald = 19.528, OR = 0.222 95%, CI = 0.114-0.433, p < 0.01). Using SMI G1 or G2 as the cutoff values for the diagnosis of active TAK, the positive predictive value, sensitivity, and specificity were 60 and 86%, 84% and 56%, and 54% and 92%, respectively. Conclusion The SMI grade is a potential marker of disease activity in patients with TAK.
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Affiliation(s)
- Feng-Ju Liu
- Department of Ultrasound, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing, China
- *Correspondence: Feng-Ju Liu,
| | - Wei-Ping Ci
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Yi Cheng
- Department of Ultrasound, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing, China
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Wu C, Liu X, Zhang H, Zhang Q, Ding S, Jin S, Zheng X, Fu C, Han Q, Shen J, Xu J, Ye N, Jiang F, Wu T. Response of human periodontal ligament to orthodontic force using superb microvascular imaging. Am J Orthod Dentofacial Orthop 2022; 162:e257-e266. [PMID: 36089442 DOI: 10.1016/j.ajodo.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Remodeling of the periodontal ligament (PDL) during orthodontic tooth movement is closely related to the vascularity of the PDL, which has not been thoroughly investigated in humans. This study aimed to measure the width and vascular parameters of human PDL using superb microvascular imaging for the first time. METHODS Patients aged 18-25 years were selected for participation. The intervention was randomly allocated from the maxillary canines to the first molars on both sides using 50 g or 150 g of force. The width and vascular parameters of the PDL were measured using superb microvascular imaging at different time intervals (baseline, 30 minutes, and 1, 3, 7, and 14 days). RESULTS Before the intervention, the width of the PDL ranged from 0.14 to 0.25 mm, and the vascular index ranged from 9.40% to 13.54%. After applying orthodontic forces, the cervical and middle PDL widths increased. The vascular index decreased slightly in 30 minutes, decreased to a minimum value after 1 day, increased to the maximum in 3-7 days, and returned to baseline values in 14 days. The values of other vascular parameters showed similar trends. CONCLUSIONS The width and vascular parameters of the PDL changed slightly after force application, underwent changes in the period of reconstruction for 3-7 days, and eventually returned to baseline in 14 days.
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Affiliation(s)
- Chuan Wu
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China
| | - Xiaoyu Liu
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China
| | - Huan Zhang
- Department of Medical Ultrasound, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qunyan Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China
| | - Siqi Ding
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China
| | - Shiyu Jin
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China
| | - Xiuyun Zheng
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China
| | - Chunfeng Fu
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China
| | - Quancheng Han
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China
| | - Jun Shen
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China
| | - Jianguang Xu
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China
| | | | - Fan Jiang
- Department of Medical Ultrasound, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Tingting Wu
- Department of Orthodontics, School and Hospital of Stomatology, Anhui Medical University, Anhui Provincial Key Laboratory of Oral Diseases, Hefei, Anhui, China.
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Danda D, Manikuppam P, Tian X, Harigai M. Advances in Takayasu arteritis: An Asia Pacific perspective. Front Med (Lausanne) 2022; 9:952972. [PMID: 36045929 PMCID: PMC9423100 DOI: 10.3389/fmed.2022.952972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Takayasu Arteritis (TA) is a rare form of chronic granulomatous large vessel vasculitis that is more common in Asia compared to other parts of the world. There have been several developments in the field of Takayasu arteritis in relation to genetics, classification, clinical features, imaging, disease activity assessment and management and much of these works have been done in the Asia Pacific region. We will be discussing selected few in the current review.
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Affiliation(s)
- Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital, Vellore, India
| | - Prathyusha Manikuppam
- Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital, Vellore, India
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - Masayoshi Harigai
- Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
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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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Oura K, Yamaguchi Oura M, Itabashi R, Maeda T. Vascular Imaging Techniques to Diagnose and Monitor Patients with Takayasu Arteritis: A Review of the Literature. Diagnostics (Basel) 2021; 11:diagnostics11111993. [PMID: 34829340 PMCID: PMC8620366 DOI: 10.3390/diagnostics11111993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/16/2021] [Accepted: 10/25/2021] [Indexed: 12/18/2022] Open
Abstract
Takayasu arteritis (TA) is a large vessel vasculitis that causes stenosis, occlusion, and sometimes the aneurysm of the aorta and its major branches. TA often occurs in young women, and because the symptoms are not obvious in the early stages of the disease, diagnosis is difficult and often delayed. In approximately 10% to 20% of patients, TA is reportedly complicated by ischemic stroke or transient ischemic attack. It is important to diagnose TA early and provide appropriate treatment to prevent complications from stroke. Diagnostic imaging techniques to visualize arterial stenosis are widely used in clinical practice. Even if no signs of cerebrovascular events are present at the time of the most recent evaluation of patients with TA, follow-up vascular imaging is important to monitor disease progression and changes in the cerebrovascular risk. However, the optimal imaging technique for monitoring of TA has not been established. Therefore, the purpose of this review is to describe newly available evidence on the usefulness of conventional imaging modalities (digital subtraction angiography, computed tomography angiography, magnetic resonance imaging/angiography, duplex ultrasound, and positron emission tomography) and novel imaging modalities (optical coherence tomography, infrared thermography, contrast-enhanced ultrasonography, and superb microvascular imaging) in the diagnosis and monitoring of TA.
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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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