The limited role of MRI in long-term follow-up of patients with Takayasu's arteritis
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)
Takayasu arteritis: lessons from the American National Institutes of Health experience
Int J Cardiol
(1996)- et al.
Flourine-18 flourodeoxyglucose positron emission tomography as a non-invasive test of disease activity in Takayasu's arteritis — a report of four cases
Autoimmun Rev
(2010) - et al.
Takayasu arteritis: a review
J Clin Pathol
(2002) - et al.
Takayasu arteritis
Ann Intern Med
(1994) - et al.
Gadolinium-enhanced three-dimensional MR angiography of Takayasu arteritis
Radiographics
(2004) - et al.
Takayasu's arteritis—recent advances in imaging offer promise
Rheumatology (Oxford)
(2007)
Cited by (38)
The Role of Imaging in Diagnosis and Monitoring of Large Vessel Vasculitis
2023, Rheumatic Disease Clinics of North AmericaTakayasu arteritis therapy: The role of imaging in the exploration of the disease and its interventional results
2020, Bulletin de l'Academie Nationale de MedecineImaging modalities for the diagnosis and disease activity assessment of Takayasu's arteritis: A systematic review and meta-analysis
2018, Autoimmunity ReviewsCitation Excerpt :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).
The Expanding Role of Imaging in Systemic Vasculitis
2016, Rheumatic Disease Clinics of North America