Perfusion-based assessment of disease activity in untreated and treated patients with aortitis and chronic periaortitis: correlation with CT morphological, clinical and serological data

Abstract

Objective: To evaluate the role of perfusion-based assessment of inflammatory activity in patients with treated and untreated aortitis and chronic periaortitis as compared with clinical and serological markers. Methods: 35 patients (20 females; median age 66 years) with (peri) aortitis were retrospectively evaluated. All patients had clinical symptoms prompting at the time of imaging. All patients first underwent whole-body contrastenhanced CT and subsequently segmental volume perfusion CT for assessment of the degree of vascularization of (peri) aortitis as a surrogate marker for inflammatory activity. Blood flow, blood volume, volume transfer constant (k-trans), time to peak and mean transit time were determined. The thickness of the increased connective tissue formation was measured. Perfusion data were correlated with clinical symptoms and acute-phase inflammatory parameters such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocyte number.Results: 21 of 35 patients were untreated and 14 of 35 had previous/ongoing immunosuppression. The interobserver agreement was good (k 5 0.78) for all perfusion parameters. Average values of perfusion parameters were higher in untreated patients but remained abnormally elevated in treated patients as well. Perfusion data and ESR and CRP correlated well both in aortitis (p , 0.05) and in periaortitis (p , 0.05). In periaortitis, perfusion parameters agreed well with ESR and CRP values (p , 0.05) only in untreated patients. Conclusion: Perfusion CT parameters in untreated aortitis and chronic periaortitis correlate well with serological markers with respect to disease activity assessment. However, in treated periaortitis, correlations were weak, suggesting an increased role for (perfusion-based) imaging. Advances in knowledge: Volume perfusion CT may be used for diagnosis of aortitis/periaortitis.

Retroperitoneal Fibrosis and its Differential Diagnoses: The Role of Radiological Imaging

“…Bier et al evaluierten die Rolle der VPCT zur Bestimmung der Entzündungsaktivität bei Patienten mit akuter und chronischer Periaortitis vor und unter Immuntherapie. In einer Studie mit 35 eingeschlossenen Patienten korrelierten die Parameter der VPCT (blood flow, blood volume, volume transfer constant k-trans, time to peak, mean transit time) bei unbehandelten Patienten signifikant mit serologischen Markern (CRP, BSG) in Bezug auf die Krankheitsaktivität, jedoch nur schwach bei behandelten Patienten, was den Stellenwert der VPCT zur initialen Diagnostik hervorhebt, einen Einsatz zur Verlaufskontrolle jedoch offen lässt [30]. Eine zweite Untersuchung mit 17 Patienten unter immunsuppressiver Therapie zeigte einen signifikanten Abfall der Parameter "bloodflow" und "bloodvolume" im Rahmen der Verlaufskontrollen mittels VPCT [31], konnte also scheinbar sehr gut die Veränderungen der Hämodynamik im Rahmen der Inflammation beschreiben.…”