Imaging modalities used in diagnosis and follow-up of patients with Takayasu’s arteritis

Abstract

Imaging modalities used in diagnosis and follow-up of patients with Takayasu's arteritis Abstract Background/aim: Takayasu's arteritis (TA) is a rare, large-vessel vasculitis of unknown etiology, affecting aortic arch and its main branches. Non-invasive imaging methods are frequently used in diagnosis and follow up in Takayasu's arteritis. Studies investigating optimal timing of follow up imaging are rare. This study is aimed to investigate the radiologic changes in vascular involvements of Takayasu's arteritis patients one year after diagnosis. Materials and methods: Database of our Vasculitis Center was analyzed retrospectively and 97 patients were included into the study. Demographic, clinical, radiological and therapeutic findings of patients were recorded. Patients with follow-up imaging after approximately one year of diagnosis were recruited into further analysis. Radiological changes and the effect of different immunosuppressive agents on vascular involvements were investigated. Results: Mean age and disease duration of patients were 43.0 and 9.0 years. The most commonly used imaging methods/modalities for the diagnosis of TA were computer tomography-angiography (CT-Ang) (58.8%), magnetic resonance-angiography (MR-Ang) (29.9%) and doppler ultrasonography (11.3%). Subclavian and common carotid arteries were the most frequently involved vessels. Fifty-three patients underwent followup imaging after one year of diagnosis and in 64% of patients same imaging method had been used. MR-Ang (62.3%) and CT-Ang (35.9%) were the most preferred followup imaging studies. Sixty-eight percent of patients had stable vascular involvement, 28% had progression and 4% had regression. No difference was found in radiological changes 3 regarding patients with usage of different immunosuppressive agents (p=0.634). There was no association between the change in serum acute phase reactants and radiological disease activity. Conclusion: The most commonly used imaging modality for the diagnosis of TA was CT-Ang whereas MR-Ang was the most preferred for follow-up. Almost 30% of TA patients in our Vasculitis center had progression at around one year concordant with previous literature. A follow up imaging at around one year of treatment, seems feasible in management of TA.

Current Diagnosis and Management of Takayasu Arteritis

“…14) Currently, the most commonly used imaging modality for diagnosis of Tak is CT angiography in most centres, and for follow up evaluation, MR angiography is preferred. 15) There is, however, no consensus on timing intervals for follow up imaging in TAK. A follow up imaging every 6 to 12 months or in the presence of suspected relapse is the ideal rather than a routine practice, while 2018 EULAR guidelines recommend imaging in the pres- ence of suspected exacerbation.…”

“…19) Table II summarises available biomarkers for assessing TAK. 11,14,15,[17][18][19][20][21][22][23][24] Autoantibodies: Even though TAK is predominantly a disease of cellular immunity, newer evidence showed the presence of B cell subsets in affected vascular tissues. This led to an extensive search for specific autoantibodies in TAK which has until now been largely unsuccessful.…”

“…Most reliable of the newer biomarkers available for disease activity assessment 18) PTX3 reflects TAK activity better than CRP or ESR 11,15) Not affected by prednisolone dose 18) Sensitivity -82.1% 18) Specificity -94.1% 18) Not specific for TAK, as the plasma levels are higher in many autoimmune diseases 14) 19,20 a sensitivity of 77% and specificity of 71% in detecting relapsing/refractory disease. 33) The Takayasu Arteritis Damage score (TADS) is specific to damage assessment in TAK, which includes 42 items grouped into 7 systems created again by IRAVAS (Indian Rheumatology Association Vasculitis) group that validated DEI.TAK and ITAS.…”

Operative experience on descending aorta with Takayasu Arteritis: a review

“…Doppler ultrasonography (Doppler US) is also used to quantify the severity of luminal narrowing as a less invasive approach. Reports indicate that among TA patients who received imaging assessment, 58.8% underwent CTA, while 29.9% underwent MRA, and Doppler ultrasonography was used in 11.3% of all patients ( 46 ).…”

“…The EULAR 2018 guidelines suggest that if the patient presents with recurrent or new symptoms, regular imaging assessment is needed during follow-up ( 49 ). Among these imaging methods, MRI is the most frequently used for follow-up because it avoids the use of radiation ( 46 ).…”