Elsevier

Autoimmunity Reviews

Volume 11, Issue 2, December 2011, Pages 132-136
Autoimmunity Reviews

The limited role of MRI in long-term follow-up of patients with Takayasu's arteritis

https://doi.org/10.1016/j.autrev.2011.09.002Get rights and content

Abstract

Introduction

MRI and MRA are used for diagnosis and activity determination of patients with Takayasu's arteritis (TA). However, there is a limited experience regarding the role of MRI in long-term follow-up of those patients. The aim of the present study was to evaluate the clinical usefulness of MRI in the long-term follow-up of patients with Takayasu's disease.

Materials and methods

The clinical data of 11 TA patients, who obtained two or more follow-up MRI scans, was matched with the imaging results.

MRI examinations were considered positive for disease activity when one of the following findings was noted: new arterial wall enhancement or interval appearance of anatomical changes (interval dilatation, stenosis or occlusion or new arterial wall irregularity). Conversely, MRI examinations were considered to show signs of improvement when local enhancement disappeared, or when a stenosis was relieved.

Disease activity was determined by the combination of worsening localizing ischemic signs and symptoms, systemic signs and symptoms (malaise, fever, etc.), and elevated blood markers (CRP and ESR).

Results

A total of 47 MRI examinations were performed in 11 patients (1 male, mean age 28, range 14–53 years) with a total follow-up time ranging between 12 and 56 months (average 36 months). MRI was positive for active disease at least once in nine out of the 11 patients (82%). The most commonly affected arteries were the aortic arch, the left subclavian artery and the left common carotid artery. No statistically significant correlation was found between clinical activity and MRI signs of activity.

Conclusion

Although MRI is a well established modality for primary diagnosis of TA, the present study suggests that it has a limited clinical role in the long-term follow-up of those patients when reactivation of disease is suspected.

Highlights

► Experience regarding the role of MRI in long-term follow-up of Takayasu's arteritis patients is limited. ► The clinical data of follow-up MRI scans of 11 TA patients was matched with their imaging results. ► No statistically significant correlation was found between clinical activity and MRI signs of activity. ► MRI is a well established modality for primary diagnosis of TA. ► However, we suggest it has a limited role in follow-up of reactivations.

Introduction

Takayasu's arteritis (TA) is a rare disease of large vessel vasculitis causing stenosis, occlusion and dilatation of the aorta and its major branches as well as the pulmonary arteries [1]. Treatment, either corticosteroids or cytotoxic, has many side-effects, and is preferentially given in active disease. Determination of an acute phase is difficult, as diagnostic criteria for activity are either unreliable (clinical symptoms and serum inflammatory markers) [2], [3] or invasive (angiography and biopsy). MRI and MRA are used as an alternative non invasive diagnostic tool for diagnosis and activity determination of TA. However, there is a limited experience regarding the role of MRI in long-term follow-up of those patients [4]. The aim of the present study was to evaluate the clinical usefulness of MRI in the long-term follow-up of patients with Takayasu's disease.

Section snippets

Materials and methods

Over a 72 month period, 25 patients were referred to the MRI unit of a University affiliated Medical Center, for assessment of TA. All patients were assessed with MRI and MRA; in 15 patients two or more follow-up scans were performed, either routinely or due to clinically suspected acute exacerbation. Matching clinical data was available in 11 of those patients who constituted the study group. These patients obtained a total of 45 MRI and MRA examinations. Maximum time interval between date of

Results

A total of 45 MRI examinations were performed in 11 patients (1 male, mean age 28, range 14–53 years) with a total follow-up time ranging between 12 and 56 months (average 36 months). Eight subjects were already known to have TA, while primary diagnosis of a suspected disease was made in the remaining three patients. Most follow-up studies included both abdominal and chest MRI. Mean interval between studies was 12 months (maximum of 40 months and minimum of 1 month). Table 1 shows subjects'

Discussion

The first stage of TA can include non-specific inflammatory features, such as fever, malaise and weight loss (the “pre-pulseless” phase), which progresses, in about 80% of the patients, to a vascular inflammatory phase [2]. If not treated, a chronic phase follows, including arterial stenosis and occlusion, with evolution of arterial wall fibrosis. The chronic phase can be steady, or progress by intermittent flares of active disease [3]. The long-term follow-up of those patients for disease

Conclusion

Although MRI is a well established modality for primary diagnosis of TA, the present study suggests that it has a limited clinical role in the long-term follow-up of those patients when reactivation of disease is suspected.

Take-home messages

  • Experience regarding the role of MRI in long-term follow-up of Takayasu's Arteritis patients is limited.

  • The clinical data of follow-up MRI scans of 11 TA patients was matched with their imaging results.

  • No statistically significant correlation was found between clinical activity and MRI signs of activity.

  • MRI is a well established modality for primary diagnosis of TA.

  • However, we suggest it has a limited role in follow-up of reactivations.

Acknowledgement of grants

This study was not supported by a grant.

References (12)

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    Primary electronic database searches identified 932 citations after the removal of duplicates (Fig. 1). Full-text review was performed on 86 articles: 29 were included in the meta-analyses (Table 1) [10–39], 28 had insufficient outcome data for pooling but were included in the systematic review (Table 2) [40–67] and 29 failed to meet inclusion/exclusion criteria (Fig. 1). The studies were from 15 different countries and most were single-centre with relatively small sample sizes (average N of 27; range 10–85 TAK patients).

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1

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2

These authors contributed equally to this paper.

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