Diffusion-weighted Whole-body Imaging with Background Body Signal Suppression (DWIBS) as a Novel Imaging Modality for Disease Activity Assessment in Takayasu's Arteritis

Abstract

A 26-year-old woman with Takayasu's arteritis (TAK) experienced back and neck pain during tocilizumab (TCZ) treatment. The levels of C-reactive protein were normal, and ultrasonography revealed no significant changes. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) showed signal enhancement in the walls of several arteries. Contrast computed tomography showed arterial inflammation in the same lesion. After increasing the dose of prednisolone and TCZ, all signal enhancements decreased and continued to decrease, as observed on days 76 and 132. Thus, DWIBS may be a novel imaging modality for assessing the disease activity of TAK, particularly during follow-up.

Untitled

“…The 5-year survival is 92.9% and 10-year survival is 87.2 % [2]. Histologically, it is characterized by a granulomatous infiltrative process of the arterial wall (acute stage) with marked intimal proliferation and fibrosis of the media and adventitia (fibrotic stage), resulting in severe stenosis, occlusion or aneurysmal dilation (from extensive destruction of elastic fibers in the media) [4,5].…”

“…The clinical manifestations of the disease are divided into early and late phases. The early or pre-pulse less phase is often characterized by non-specific signs and general symptoms of systemic inflammation (fever, weight loss, night sweats, weakness, myalgia, arthralgia), whereas the late or pulse less phase (consequences of vascular inflammation or fibrosis) may be associated with symptoms of ischemia of limb, renovascular hypertension, pulmonary hypertension, pulmonary embolism, myocardial ischemia and neurological symptoms [3][4][5][6].…”

“…MRI with enhancement of the thickened walls with gadolinium contrast suggests the active phase of TA. FDG-PET, CT and US as alternative imaging modalities in patients suspected TA [3,5]. During our diagnosis process; neck US was wanted to understand the etiology of neck pain, with the suspicion of US, CT angiography was carried out to understand if there was a leakage through the arterial wall.…”

Evaluation of tocilizumab for intractable Takayasu arteritis and 18F-fluorodeoxyglucose-positron emission tomography for detecting inflammation under tocilizumab treatment

“…One shortcoming of TCZ is its suppression of inflammatory biomarkers, even in patients with recurrence of TAK activity. In particular, suppression of C-reactive protein, which is the most commonly used inflammatory biomarker for tracking TAK disease activity in daily clinical practice [14][15][16] , makes diagnosis of recurrence of inflammation difficult in patients under treatment with TCZ, and leaves physicians without a quantitative measure of inflammation [17] .…”

Clinical Utility of Diffusion-weighted Whole-body Magnetic Resonance Imaging with Background Body Signal Suppression for Assessing and Monitoring IgG4-related Disease

“…Diffusionweighted imaging with background body signal suppression (DWIBS), introduced by Takahara et al (5) in 2004, is a relatively new imaging modality. It is primarily used for cancer screening or staging, and a few reports have addressed the utility of DWIBS for patients with arteritis (6,7).…”