Abstract:Imaging is becoming increasingly important for the diagnosis of large vessel vasculitis (LVV). Atherosclerosis may be difficult to distinguish from LVV on imaging as both are inflammatory conditions of the arterial wall. Differentiating atherosclerosis from LVV is important to enable optimal diagnosis, risk assessment, and tailored treatment at a patient level. This paper reviews the current evidence of ultrasound (US), 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET), computed tomography… Show more
“…Among them, US of the temporal arteries is now considered the first tool to evaluate patients with suspected GCA. This rapid access imaging technique allows non-invasive identification of patients with cranial manifestations who are at increased risk of developing blindness and other serious vascular complications [8,9,16,25,35,36,61]. US can also be useful for the evaluation of extracranial vessels such as the axillary arteries.…”
Section: Discussionmentioning
confidence: 99%
“…Atherosclerosis has also been considered a pitfall in the interpretation of PET/CT. Although a distinctive diffuse pattern of vascular FDG uptake is observed in patients with LVV, while atherosclerosis usually shows a focal or "patchy" uptake, distinguishing atherosclerosis and LVV can be challenging [61,62]. Experts recommend the use of semiquantitative measurements and cumulative vascular scores for PET/CT interpretation, and the combined use of PET and CTA whenever possible in order to avoid false-positive results [62].…”
Early recognition of giant cell arteritis (GCA) is crucial to avoid the development of ischemic vascular complications, such as blindness. The classic approach to making the diagnosis of GCA is based on a positive temporal artery biopsy, which is among the criteria proposed by the American College of Rheumatology (ACR) in 1990 to classify a patient as having GCA. However, imaging techniques, particularly ultrasound (US) of the temporal arteries, are increasingly being considered as an alternative for the diagnosis of GCA. Recent recommendations from the European League Against Rheumatism (EULAR) for the use of imaging techniques for large vessel vasculitis (LVV) included US as the first imaging option for the diagnosis of GCA. Furthermore, although the ACR classification criteria are useful in identifying patients with the classic cranial pattern of GCA, they are often inadequate in identifying GCA patients who have the extracranial phenotype of LVV. In this sense, the advent of other imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET)/CT, has made it possible to detect the presence of extracranial involvement of the LVV in patients with GCA presenting as refractory rheumatic polymyalgia without cranial ischemic manifestations. Imaging techniques have been the key elements in redefining the diagnostic work-up of GCA. US is currently considered the main imaging modality to improve the early diagnosis of GCA.
“…Among them, US of the temporal arteries is now considered the first tool to evaluate patients with suspected GCA. This rapid access imaging technique allows non-invasive identification of patients with cranial manifestations who are at increased risk of developing blindness and other serious vascular complications [8,9,16,25,35,36,61]. US can also be useful for the evaluation of extracranial vessels such as the axillary arteries.…”
Section: Discussionmentioning
confidence: 99%
“…Atherosclerosis has also been considered a pitfall in the interpretation of PET/CT. Although a distinctive diffuse pattern of vascular FDG uptake is observed in patients with LVV, while atherosclerosis usually shows a focal or "patchy" uptake, distinguishing atherosclerosis and LVV can be challenging [61,62]. Experts recommend the use of semiquantitative measurements and cumulative vascular scores for PET/CT interpretation, and the combined use of PET and CTA whenever possible in order to avoid false-positive results [62].…”
Early recognition of giant cell arteritis (GCA) is crucial to avoid the development of ischemic vascular complications, such as blindness. The classic approach to making the diagnosis of GCA is based on a positive temporal artery biopsy, which is among the criteria proposed by the American College of Rheumatology (ACR) in 1990 to classify a patient as having GCA. However, imaging techniques, particularly ultrasound (US) of the temporal arteries, are increasingly being considered as an alternative for the diagnosis of GCA. Recent recommendations from the European League Against Rheumatism (EULAR) for the use of imaging techniques for large vessel vasculitis (LVV) included US as the first imaging option for the diagnosis of GCA. Furthermore, although the ACR classification criteria are useful in identifying patients with the classic cranial pattern of GCA, they are often inadequate in identifying GCA patients who have the extracranial phenotype of LVV. In this sense, the advent of other imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET)/CT, has made it possible to detect the presence of extracranial involvement of the LVV in patients with GCA presenting as refractory rheumatic polymyalgia without cranial ischemic manifestations. Imaging techniques have been the key elements in redefining the diagnostic work-up of GCA. US is currently considered the main imaging modality to improve the early diagnosis of GCA.
“…Atherosclerosis does not show any contrast enhancement, and wall thickening is eccentric and focal. 11 Conversely, vasculitis shows perivascular contrast enhancement and wall thickening can be characterized as concentric and in a long vessel segment in MRA images. Atheroma plaques may cause mild local inflammation, and CTA may detect slight and irregular, nonconcentric wall thickening surrounding the plaque.…”
Background and aim: Takayasu's arteritis (TA) is a chronic inflammation that frequently involves the aorta and its major branches. It has been known that atherosclerosis can occur in some TA patients. Objectives: This study aimed to identify the risk factors associated with the development of atherosclerosis in TA. Methods: This retrospective study enrolled a total of 101 TA patients. All patients were divided into two groups according to the absence or presence of atherosclerosis. Baseline demographic features and clinical characteristics were compared between two groups. A logistic model was applied to determine the risk factors associated with the development of atherosclerosis. Results: Our data suggested that the disease duration of patients in the atherosclerosis group was significantly longer than that of patients in the non-atherosclerosis group [96(18.00, 180.00) versus 48.00(12.00, 111.00) months] ( P = .015). In addition, the average age of patients with atherosclerosis was significantly older compared to patients without atherosclerosis [44.00(38.00, 48.00)versus 28.50(24.00，37.00)years] ( P < .001). Logistic regression analysis showed that the risk of developing atherosclerosis increased by 9.2% per 1 year increase in the disease duration ( P = .005, OR 1.092, 95%CI: 1.027-1.162). Patients with TG/HDL-C ratio more than 0.8875 were associated with a 5.861fold increase of risk developing atherosclerosis ( P < .001, OR 5.861, 95%CI: 2.299-14.939). Conclusion: Our study indicated that prolonged disease duration and elevated TG/HDL-C ratio are associated with the development of atherosclerosis in TA patients.
“…Obliteration or stenosis of the arterial lumen leads to decreased perfusion in abdominal organs, and in case vasa vasorum is involved, it can result in intestinal ischemia. Furthermore, diffuse intimal calcification may occur as a result of chronic vascular inflammation [ 14 ]. Fig.…”
Section: Classification Of Vasculitis: An Overviewmentioning
Diagnosis of intestinal vasculitis is often challenging due to the non-specific clinical and imaging findings. Vasculitides with gastrointestinal (GI) manifestations are rare, but their diagnosis holds immense significance as late or missed recognition can result in high mortality rates. Given the resemblance of radiologic findings with some other entities, GI vasculitis is often overlooked on small bowel studies done using computed tomography/magnetic resonance enterography (CTE/MRE). Hereon, we reviewed radiologic findings of vasculitis with gastrointestinal involvement on CTE and MRE. The variety of findings on MRE/CTE depend upon the size of the involved vessels. Signs of intestinal ischemia, e.g., mural thickening, submucosal edema, mural hyperenhancement, and restricted diffusion on diffusion-weighted imaging, are common in intestinal vasculitis. Involvement of the abdominal aorta and the major visceral arteries is presented as concentric mural thickening, transmural calcification, luminal stenosis, occlusion, aneurysmal changes, and collateral vessels. Such findings can be observed particularly in large- and medium-vessel vasculitis. The presence of extra-intestinal findings, including within the liver, kidneys, or spleen in the form of focal areas of infarction or heterogeneous enhancement due to microvascular involvement, can be another radiologic clue in diagnosis of vasculitis. The link between the clinical/laboratory findings and MRE/CTE abnormalities needs to be corresponded when it comes to the diagnosis of intestinal vasculitis.
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