Trudności w obrazowaniu choroby Takayasu – opis przypadku i przegląd literatury

Abstract

SummaryBackground:Takayasu arteritis is an inflammatory disease of large-diameter arteries. Aorta and its branches are most frequently affected. Takayasu arteritis occurs mainly in young women and, if left untreated, leads to fatal complications. Digital subtraction angiography (DSA) is considered the gold standard in imaging of Takayasu arteritis.Case Report:A thirty-five-year-old woman was admitted to the hospital with transient loss of consciousness, effort-associated vertigo, upper limb weakness and temporary vision problems. On admission, there was no pulse on the left radial artery while there were bruits over subclavian arteries. Imaging of the aortic arch (computed tomography angiography, DSA) revealed stenoses of its main branches, indicating Takayasu arteritis.Conclusions:Computed tomography angiography (CTA) performed with a 64-slice unit revealed high effectiveness in localization of vascular wall and lumen pathologies resulting from Takayasu arteritis. Thanks to this fast diagnostic method, it is now possible to perform successful monitoring of patients with Takayasu arteritis and to plan possible interventional treatment.

Role of inflammatory markers in Takayasu arteritis disease monitoring

“…The pathological changes occurring in all layers lead to the narrowing of the vascular lumen, which result in stenosis and occlusion. In the chronic phase, inflammatory lesions progress to scars and the vessels become fibrotic and calcified [ 8 ]. When fibrosis is insufficient, as when lesions progress rapidly, the arterial wall is thinned and dilation and aneurysms occur.…”

“…Additionally, CRP is produced in the liver in response to the circulating cytokine IL-6, rather than at the site of inflammation, which may account for its low sensitivity [ 7 , 21 , 23 ]. Relying on these inflammatory markers alone to monitor disease progression can have severe and even lethal consequences for patients [ 8 , 10 ]. Therefore, ESR and CRP should be viewed in the context of the patient’s clinical course and imaging.…”

“…CTA allows evaluation of the vessel wall and lumen in the aorta and large vessels and can provide information concerning end organ ischemia. However, it is costly, exposes the patient to higher radiation than other imaging modalities, and is impractical for frequent monitoring [ 8 , 28 ].…”

“…MR angiography (MRA) with gadolinium contrast facilitates visualization of pathological wall enhancement and has demonstrated a sensitivity and specificity of up to 100% in diagnosing TA [ 30 , 31 ]. However, MRI is time consuming, expensive, can be affected by movement artifact, cannot be performed in patients with ferromagnetic implants, and may require 3 Tesla strength in order to visualize smaller vessels [ 8 ].…”

Diffusion-weighted Whole-body Imaging with Background Body Signal Suppression (DWIBS) as a Novel Imaging Modality for Disease Activity Assessment in Takayasu's Arteritis

“…CT angiography enables the assessment of the vessel walls and lumen and can provide information regarding organ ischemia (13). However, this method is costly and exposes the patient to higher levels of radiation than other imaging modalities.…”