Case report: imaging of Takayasu arteritis in the acute stage

Magnetic resonance imaging features of aortic diseases

The usefulness of magnetic resonance imaging (MRI) for aortic diseases is discussed, with special attention given to the MRI features of aortic dissection and Takayasu arteritis. Computed tomography (CT) and MRI provide excellent visualization of vessels and their relationship to surrounding structures; however, CT depicts the vessel lumen optimally only when contrast enhancement is used. MRI, with its inherent multiplanar imaging capability, is well suited for evaluation of the thoracic and abdominal aorta and can be used with or without contrast enhancement. Basic technical considerations in cardiac imaging, which include conventional spin-echo, fast spin-echo, cine gradient, and echo-planar imaging, with time-of-flight and phase-contrast methods, are discussed and applied to aortic aneurysm, aortic dissection, and Takayasu arteritis. The diagnostic capacity of spin-echo MRI in patients with suspected aortic dissection is enhanced when it is combined with cine MRI. Despite the ability of CT and MRI to demonstrate luminal and mural changes of aortic abnormalities, conventional angiography still may be necessary at first admission for selected patients in the late occlusive phase to provide additional information on the degree and extent of the arteritis. CT angiography and MR angiography are promising imaging techniques that will overcome difficulties in visualizing distal branch vessel lesions and obviate the need for conventional angiography in the near future.

Magnetic resonance imaging in the diagnosis and follow up of Takayasu's arteritis in children

BACKGROUND

Takayasu's arteritis (TA) has a mortality rate of up to 40% in children. Because the clinical presentation of TA is often non-specific, accurate and prompt diagnosis depends on a high degree of awareness and appropriate laboratory and imaging studies.

OBJECTIVE

To examine the use of advanced magnetic resonance imaging (MRI) in evaluating, gauging activity, and following the complications of TA.

METHODS AND RESULTS

T1 weighted, T2 weighted, contrast enhanced MR images, and MR angiograms of the chest and abdomen were obtained in three children (age range 11-14 years). The MRI studies confirmed the diagnosis of active TA and were repeated to evaluate response to treatment. Two patients showed complete resolution of lesions found on MRI at six and 12 months' follow up, while the third patient showed no significant improvement.

CONCLUSION

MRI can be used to help establish the initial diagnosis of TA in children, and it can also be used to monitor disease activity and to guide treatment.

Takayasu's arteritis presenting as fever of unknown origin: report of two cases and literature review

OBJECTIVES

This study reports two patients with Takayasu's arteritis presenting with a fever of unknown origin (FUO) and reviews the literature on that association.

METHODS

We describe the clinical presentation, course, and outcome of the two patients, and reviewed the medical literature from 1968 till 1997 using MEDLINE and the key words fever, diagnosis, and Takayasu's arteritis.

RESULTS

Takayasu's arteritis is rarely reported as a cause of FUO. Noninvasive diagnostic techniques such as magnetic resonance imaging, computed tomography scanning, gallium-67 scintigraphy, and ultrasonography may help in the diagnosis of Takayasu's arteritis in the prepulseless stage.

CONCLUSION

Takayasu's arteritis should be considered in the differential diagnosis of FUO, especially in young women.

FDG-PET finding in early-phase Takayasu arteritis

We report a unique case of early-phase Takayasu arteritis in which the vessels demonstrated accumulation of [18F]fluorodeoxyglucose (FDG) on PET scanning. This observation suggests the possible use of FDG-PET for the diagnosis of vasculitis. Early diagnosis of Takayasu arteritis may permit early treatment and possibly could prevent progression to the occlusive or pulseless phase of this disease.

Diffuse pulmonary lesions in early phase Takayasu arteritis predominantly involving pulmonary artery

We report a case of early phase Takayasu arteritis that predominantly involved the pulmonary arteries and had, along with expected radiographic findings, the unusual pattern of diffuse pulmonary parenchymal lesions on CT. We suggest that this finding may be an additional feature in early phase Takayasu arteritis and need not require investigation for an additional diagnosis.

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

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

Pulmonary arterial lesions in Takayasu arteritis: relationship of inflammatory activity to scintigraphic findings and sequential changes

In order to investigate the relationship between inflammatory activity and pulmonary arterial changes in Takayasu arteritis and the progression of the disease, we retrospectively reviewed 110 perfusion lung scans obtained by using 99mTc-macroaggregated albumin in a total of 57 patients. The scintigraphic findings were compared with the inflammatory activity and clinical course. Inflammatory activity was determined on the basis of the physical findings and laboratory data, i.e., the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) value. Scintigraphic abnormality was seen in 32 (56%) of the patients. The incidence of scintigraphic abnormality in the patients with active inflammation (7 of 21 patients, 33%) was lower than that in the patients in the chronic stage (22 of 32, 69%) (p < 0.02). Six of 22 patients who had undergone more than one scintigraphic examination showed progression in the scintigraphic findings. Four of the 6 patients showed relapse clinically, and corticosteroid medication could not be withdrawn from them. The lower incidence of scintigraphic abnormality in the patients with active inflammation suggests that in the acute phase no stenotic or occlusive changes in the pulmonary artery have yet been produced. Pulmonary arterial lesions can progress. The incidence of progression may be slightly higher in the patients who have had a relapse after corticosteroid therapy than in those who remained in remission after therapy or who were in the chronic stage, although neither difference was significant.