Imaging in large-vessel vasculitis

Schmidt, Wolfgang A.; Nielsen, Berit Dalsgaard

doi:10.1016/j.berh.2020.101589

Cited by 20 publications

(12 citation statements)

References 89 publications

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“…It should also be underlined that although atherosclerosis can be distinguished from vasculitis it is far less common in temporal and axillary arteries compared to carotid arteries. Thus, atherosclerosis can disturb the sonographic evaluation of arteritis especially in other arteries than temporal and axillary arteries ( 18 , 24 ). We found that the majority of patients demonstrated plaque in the carotid bifurcation or in three or more vessels.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Performance of an Extended Ultrasound Protocol in Patients With Clinically Suspected Giant Cell Arteritis

et al. 2022

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ObjectiveTo evaluate the diagnostic performance of an extended ultrasound protocol in patients referred under the suspicion of giant cell arteritis (GCA).MethodsConsecutive patients with suspected GCA were examined with an extended color duplex ultrasound (CDU) protocol during a period of 2 years. The extended CDU protocol included temporal, axillary, subclavian, brachiocephalic, and carotid arteries. The reference was clinically diagnosed GCA, confirmed after ≥6-month follow-up. Hypo- or medium-echogenic, circumferential, homogenous wall thickening, and/or a positive compression sign in temporal arteries, were regarded as typical signs of arteritis.ResultsOf the eligible 201 patients, 83 (41%) received a clinical GCA diagnosis at follow-up ≥6 months post CDU examination. Among these cases, 48 (58%) demonstrated inflammation solely in temporal arteries, 8 (10%) showed abnormalities restricted to extra-cranial vessels, and 23 (28%) patients displayed inflammatory changes in both temporal and extra-cranial arteries. Color duplex ultrasound of temporal arteries yielded a diagnostic sensitivity and specificity [95% confidence intervals (CI)] of 86% (76–92%) and 99% (95–99%), respectively. By adding axillary artery examination, the sensitivity increased to 92% (83–97%) while the specificity remained unchanged. Further, inclusion of subclavian artery marginally increased the sensitivity by 1%. Finally, by also including brachiocephalic and common carotid arteries resulted in a sensitivity of 95% (88–99%) and a specificity of 98% (94–99%).ConclusionsColor duplex ultrasound examination demonstrated a high accuracy in diagnosing patients both with cranial and extra-cranial GCA. Further examination of brachiocephalic and common carotid arteries can increase the sensitivity without affecting the specificity when temporal and axillary findings are indecisive. Finally, the extended CDU protocol allows measurement of the general burden of inflammation, which could be relevant for future monitoring purposes.

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Section: Discussionmentioning

confidence: 99%

The Diagnostic Performance of an Extended Ultrasound Protocol in Patients With Clinically Suspected Giant Cell Arteritis

et al. 2022

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“…Extracranial giant cell arteritis is the most frequent etiology of aortitis with classical MRI signatures previously described. Significant wall thickening with consequent stenosis and aneurysmatic dilatation characterize Takayasu arteritis with specific involvement of aorta and main branches, more frequently subclavian arteries ( Figure 4 ) ( 67 ). Pulmonary artery involvement has been reported in up to 70% of cases but the real prevalence is still unknown ( 68 ).…”

Section: Cmr In Systemic Vasculitismentioning

confidence: 99%

Role of Cardiovascular Magnetic Resonance to Assess Cardiovascular Inflammation

Filomena

Dresselaers

Bogaert

2022

Front. Cardiovasc. Med.

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Cardiovascular inflammatory diseases still represent a challenge for physicians. Inflammatory cardiomyopathy, pericarditis, and large vessels vasculitis can clinically mimic a wide spectrum of diseases. While the underlying etiologies are varied, the common physio-pathological process is characterized by vasodilation, exudation, leukocytes infiltration, cell damage, and fibrosis. Cardiovascular magnetic resonance (CMR) allows the visualization of some of these diagnostic targets. CMR provides not only morphological and functional assessment but also tissue catheterization revealing edema, hyperemia, tissue injury, and reparative fibrosis through T2 weighted images, early and late gadolinium enhancement, and parametric mapping techniques. Recent developments showed the role of CMR in the identification of ongoing inflammation also in other CV diseases like myocardial infarction, atherosclerosis, arrhythmogenic and hypertrophic cardiomyopathy. Future developments of CMR, aiming at the specific assessment of immune cell infiltration, will give deeper insight into cardiovascular inflammatory diseases.

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“…Ultrasound (US), including echocardiography, can be a helpful cardiovascular screening test but can underestimate or incompletely characterize the full extent of disease. Conventional angiography is preferably reserved for concurrent intervention [ 10 , 11 ]. In general, the purpose of imaging in medium- to large-vessel vasculitis is to evaluate the vessels, while the goal in small- to medium-vessel vasculitis is to assess for end-organ disease complications.…”

Section: Imaging Approachmentioning

confidence: 99%

“…CT is generally more optimal for assessing the lungs, airways and coronaries as well as any calcifications (e.g., from chronic inflammation) or metallic material (e.g., post-surgical stents). MRI offers improved tissue (e.g., vessel wall) characterization and nearly comparable spatial resolution without ionizing radiation and potentially without contrast agent [ 1 , 2 , 10 , 11 ]. Nevertheless, these traditional distinctions have become increasingly blurred with ongoing advances both in CT (e.g., dual-energy/spectral CT for improved tissue contrast; CT-derived fractional flow reserve for coronary stenosis hemodynamic interrogation) and MRI (e.g., ultrashort echo time [UTE] and zero echo time [ZTE] techniques with conical or radial k-space sampling for lung and airway assessment; four-dimensional [4-D] blood-flow interrogation) [ 12 – 16 ].…”

Section: Imaging Approachmentioning

confidence: 99%

Pediatric cardiothoracic vasculitis: multimodality imaging review

Chan

2022

Pediatr Radiol

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The pediatric vasculitides are a relatively uncommon and heterogeneous group of disorders characterized by vessel inflammation, often with cardiothoracic involvement. Diagnosis and monitoring are often clinically challenging because of the nonspecific symptoms and laboratory markers. Thus, imaging has assumed increasing importance for early detection of disease activity, extent and complications as well as long-term monitoring pre- and post-treatment. Herein, we review the major pediatric vasculitides with frequent chest manifestations, including Takayasu arteritis, Kawasaki disease, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, Behçet disease and potential mimics. We highlight key clinical features and management considerations, emphasizing the central role of imaging.

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Imaging in large-vessel vasculitis

Cited by 20 publications

References 89 publications

The Diagnostic Performance of an Extended Ultrasound Protocol in Patients With Clinically Suspected Giant Cell Arteritis

The Diagnostic Performance of an Extended Ultrasound Protocol in Patients With Clinically Suspected Giant Cell Arteritis

Role of Cardiovascular Magnetic Resonance to Assess Cardiovascular Inflammation

Pediatric cardiothoracic vasculitis: multimodality imaging review

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