Value of whole-body contrast-enhanced magnetic resonance angiography with vessel wall imaging in quantitative assessment of disease activity and follow-up examination in Takayasu’s arteritis

Abstract

The aim of this study is to determine the value of whole-body contrast-enhanced magnetic resonance angiography(CE-MRI) with vessel wall imaging in quantitative assessments of Takayasu's arteritis (TA) disease activity and follow-up examinations. Whole-body CE-MRI with vessel wall imaging (dark blood sequences) was performed in 52 TA patients and repeated in 15 patients after 6 months. Images were analyzed using quantitative scores. The distribution of Lupi-Herrera types (type III, 48.1 %; I, 40.4 %; II, 9.6 %; IV, 1.9 %) did not differ between active and inactive TA. Active vessel inflammation was found in seven patients diagnosed with inactive disease as Kerr scores and mainly involved the aortic arch, abdominal aorta, and ascending aorta. Quantitative MR scores were significantly higher in active TA (luminal stenosis 16.7 ± 5.3 vs. 4.2 ± 3.7, p < 0.01; wall thickening 7.2 ± 3.4 vs. 2.9 ± 2.3, p = 0.02; wall enhancement 8.7 ± 4.1 vs. 3.6 ± 2.4, p = 0.04) and positively correlated with Kerr scores, ITAS 2010, erythrocyte-sedimentation rate (ESR), and C-reactive protein (CRP) and pentraxin-3 (PTX-3) levels. At 6 months, the clinical symptoms, CRP level, and ESR improved significantly (p < 0.05) and wall enhancement decreased (6.7 ± 3.1 vs. 4.1 ± 2.1; p = 0.04), but the luminal stenosis (10.2 ± 4.3 vs. 8.8 ± 5.2; p = 0.12) and wall thickening (6.3 ± 3.8 vs. 5.8 ± 4.2; p = 0.27) remained unchanged. Whole-body CE-MRI with vessel wall imaging detected luminal changes and vessel wall inflammation in TA. Our MR scoring system enabled quantitative assessment of TA activity.

Radiology and biomarkers in assessing disease activity in Takayasu arteritis

“…Arterial wall thickening and more intense post‐contrast enhancement may reflect active disease . A moderate relationship has been demonstrated between disease activity index, including acute‐phase reactants and NIH scores, and qualitative MRI in our previous studies . However, there are also several studies showing that arterial enhancement after paramagnetic contrast medium infusion was similar in active and inactive disease .…”

Imaging in Giant Cell Arteritis

“…However, even oedema-weighted imaging was found to demonstrate oedema in 56 % of cases in clinical remission based on National Institutes of Health criteria [73]. A further report complicates the picture by suggesting mural thickening correlates with disease activity at diagnosis, but that reduction in mural enhancement more reliably reflects reduced disease activity at 6 months [74].…”

High-resolution vessel wall magnetic resonance imaging of carotid and intracranial vessels

“…The potential mechanisms of wall enhancement in vasculitis include increased permeability of the endothelium, vasa vasorum-related contrast leakage (43), and dilated neovessels within the extracranial arterial wall of patients with Takayasu arteritis (71). Although the results were not consistent, the observed wall enhancement is often considered to be associated with the activation of vasculitis (72,73). Therefore, non-enhancement of the arterial wall cannot exclude the possibility of vasculitis and the follow-up imaging to monitor the change in vascular enhancement is important for patients with a suspected or confirmed diagnosis.…”