An extended high‐frequency ultrasound protocol for detection of vessel wall inflammation

Zachrisson, Helene; Svensson, Christina; Dremetsika, Asimina; Eriksson, Per

doi:10.1111/cpf.12450

Cited by 10 publications

(16 citation statements)

References 19 publications

(34 reference statements)

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“…Areas of increased IMT (≥0.9 mm in CCA, ICA, SCA, and CFA; ≥1.2 mm in the aortic arc) without atherosclerotic plaques showed regular wall thickening of medium echogenicity. We have recently shown that an extended US protocol is of value for the assessment of giant cell arteritis ( 39 ) and Takayasu arteritis ( 28 ). In these diseases, US appearance of the vessel walls was characterized by a smooth, circumferential, homogenous increased IMT, with or without fibrotic stripes depending on different stages of the disease.…”

Section: Discussionmentioning

confidence: 99%

High-Frequency Ultrasound of Multiple Arterial Areas Reveals Increased Intima Media Thickness, Vessel Wall Appearance, and Atherosclerotic Plaques in Systemic Lupus Erythematosus

et al. 2020

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Introduction: Despite improved therapies and management, patients with systemic lupus erythematosus (SLE) still have increased risks of cerebrovascular and cardiovascular disease. High-frequency ultrasound (US) provides an opportunity to distinguish atherosclerosis from inflammation in the vessels. We hypothesized that an extended US protocol may add information regarding vascular affection in SLE. Methods: Sixty patients (52 women, 8 men; mean age 43.2 ± 11.3 years) with SLE characterized by either lupus nephritis (LN; n = 20), antiphospholipid syndrome (APS; n = 20), or skin and joint involvement ( n = 20) as well as matched healthy controls ( n = 60) were included. Intima-media thickness (IMT), assessment of vessel walls, and plaque occurrence were recorded using high-frequency US (GE Logic E9) in common carotid, internal carotid, brachiocephalic, subclavian, axillary, common femoral, and proximal superficial femoral arteries as well as in the aortic arch. Results: For the entire SLE group, IMT was increased in the internal carotid artery (0.52 ± 0.17 vs. 0.45 ± 0.09 mm, p = 0.004), the common femoral artery (0.57 ± 0.23 vs. 0.49 ± 0.11 mm, p < 0.01), the subclavian artery (0.58 ± 0.19 vs. 0.53 ± 0.13 mm, p = 0.02), and the aortic arch (1.21 ± 0.63 vs. 0.98 ± 0.25 mm, p = 0.002) compared to controls. These differences were primarily observed in the APS and LN groups compared to controls. Vessels with increased IMT ≥0.9 mm had a smooth, medium echogenic appearance in areas free of atherosclerotic plaques. Atherosclerotic plaques were detected in 15/60 patients (25%) as compared to 2/60 of the controls (3%). Plaques were predominantly (67%) located in the carotid bifurcation. Multivariate analysis revealed influence of age on IMT in all vessel areas. Furthermore, in the common femoral artery, sagittal abdominal diameter, diastolic blood pressure, and cholesterol all showed association with increased IMT. In the internal carotid artery, male sex and presence of Raynaud phenomenon influenced IMT. Conclusion: Among SLE patients without presence of plaques, an extended US protocol revealed increased wall thickness with predominantly medium echogenic appearance highlighting possibly inflammation or early atherosclerosis. The appearance of vessel walls has not previously been studied in detail. An increased number of plaques were found in SLE compared to age- and sex-matched healthy controls. We found similar risk factors for increased IMT and occurrence of plaques, possibly indicating atherosclerotic mechanisms rather than inflammation.

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Section: Discussionmentioning

confidence: 99%

High-Frequency Ultrasound of Multiple Arterial Areas Reveals Increased Intima Media Thickness, Vessel Wall Appearance, and Atherosclerotic Plaques in Systemic Lupus Erythematosus

et al. 2020

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“…In this study, we showed that both increased IMT, the difference between vessel diameter and lumen diameter and Takayasu ultrasound index could be used as ultrasound activity parameters combined with vessel wall appearance. According to our previous study, it is important to use a standardized protocol including fixed points for measurements of inflammatory wall changes (Zachrisson et al, 2018). Park et al (2001) suggested that a vessel diameter exceeding 10 mm should indicate inflammatory activity and used it in follow-up studies.…”

Section: Discussionmentioning

confidence: 99%

Vascular ultrasound for monitoring of inflammatory activity in Takayasu arteritis

Svensson

Eriksson

Zachrisson

2019

Clin Physio Funct Imaging

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Background Takayasu arteritis (TA) is a rare large-vessel arteritis that primarily affects the aorta and its major branches. The aim of this study was to describe the value of high frequency ultrasound for monitoring of inflammatory activity. Methods Twenty-five patients, range 11-71 years, diagnosed with TA were investigated with duplex ultrasound (DUS) including follow-up studies. Twenty-five healthy controls were also investigated. Nine patients had newly diagnosed active TA. Sixteen patients had stable/inactive disease at baseline DUS, and TA was diagnosed median 4Á5 years previously. Intima-media thickness (IMT), vessel and lumen diameter were measured in the carotid arteries, central neck arteries and the aortic arch. The vessel walls were studied qualitatively. The Takayasu ultrasound index was created for inflammatory activity scoring. Results Intima-media thickness in common carotid artery (CCA) was (median and 25-75 percentile parenthetic) 2Á3 mm (1Á7-2Á9) in clinically active TA, 1Á2 mm (1Á1-1Á6) in clinically stable TA (P<0Á001) and 0Á5 mm (0Á5-0Á6) in healthy controls (P<0Á001). Clinically active TA had prominent increase in IMT and/or increased vessel diameter, and/or intramural arteries, and/or hypoechogenic areas interpreted as oedema in the vessel wall. TA in clinical remission was characterized by increased IMT with medium to high echogenicity with or without fibrotic stripes. The Takayasu ultrasound index was higher in patients with active disease versus treated disease, 2Á55 (1Á60-3Á05) versus 1Á30 (1Á00-1Á58), (P = 0Á003). Conclusion DUS is an excellent tool to monitor inflammatory changes in the vessel wall in TA. Further DUS studies in larger patient populations are warranted.

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“…Atherosclerosis was thought unlikely as the wall thickening was uniform, homogenous and circumferential and rather than heterogeneous and eccentric as expected with atherosclerotic plaque . TAK and GCA account for the vast majority of large vessel vasculitides, with GCA being 10 times more common than TAK . GCA may affect the large arteries including the aorta as is seen in this case, however, TAK is far more likely to involve the mesenteric arteries .…”

Section: Discussionmentioning

confidence: 50%

“…Differential diagnoses to consider include giant cell arteritis (GCA), also referred to as temporal arteritis, and atherosclerosis . Atherosclerosis was thought unlikely as the wall thickening was uniform, homogenous and circumferential and rather than heterogeneous and eccentric as expected with atherosclerotic plaque . TAK and GCA account for the vast majority of large vessel vasculitides, with GCA being 10 times more common than TAK .…”

Section: Discussionmentioning

confidence: 97%

Ultrasound of type 4 Takayasu's arteritis with abdominal aorta and visceral artery stenosis

Wyatt¹

2018

Sonography

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An extended high‐frequency ultrasound protocol for detection of vessel wall inflammation

Abstract: An extended ultrasound protocol for central neck and leg arteries could be of value for diagnosis of arteritis. In case of atypical vessel wall inflammation, other main diagnoses should be considered.

Cited by 10 publications

References 19 publications

High-Frequency Ultrasound of Multiple Arterial Areas Reveals Increased Intima Media Thickness, Vessel Wall Appearance, and Atherosclerotic Plaques in Systemic Lupus Erythematosus

High-Frequency Ultrasound of Multiple Arterial Areas Reveals Increased Intima Media Thickness, Vessel Wall Appearance, and Atherosclerotic Plaques in Systemic Lupus Erythematosus

Vascular ultrasound for monitoring of inflammatory activity in Takayasu arteritis

Ultrasound of type 4 Takayasu's arteritis with abdominal aorta and visceral artery stenosis

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