Vascular Imaging Techniques to Diagnose and Monitor Patients with Takayasu Arteritis: A Review of the Literature

Abstract

Takayasu arteritis (TA) is a large vessel vasculitis that causes stenosis, occlusion, and sometimes the aneurysm of the aorta and its major branches. TA often occurs in young women, and because the symptoms are not obvious in the early stages of the disease, diagnosis is difficult and often delayed. In approximately 10% to 20% of patients, TA is reportedly complicated by ischemic stroke or transient ischemic attack. It is important to diagnose TA early and provide appropriate treatment to prevent complications from stroke. Diagnostic imaging techniques to visualize arterial stenosis are widely used in clinical practice. Even if no signs of cerebrovascular events are present at the time of the most recent evaluation of patients with TA, follow-up vascular imaging is important to monitor disease progression and changes in the cerebrovascular risk. However, the optimal imaging technique for monitoring of TA has not been established. Therefore, the purpose of this review is to describe newly available evidence on the usefulness of conventional imaging modalities (digital subtraction angiography, computed tomography angiography, magnetic resonance imaging/angiography, duplex ultrasound, and positron emission tomography) and novel imaging modalities (optical coherence tomography, infrared thermography, contrast-enhanced ultrasonography, and superb microvascular imaging) in the diagnosis and monitoring of TA.

Ultrasound Assessment and Vascular Mechanics in Takayasu Arteritis and Systemic Lupus Erythematosus

“…Concentric wall thickening, oedema and wall mural contrast enhancement can be visualised, as well as narrowing of the lumen, occlusions and aneurysms. To differentiate between active and stable disease forms, MRI is more unreliable, as it often displays false-positive results (22).…”

“…High sensitivity and specificity have been observed, with significantly higher uptake of FDG in active than in inactive disease. A new score, the PET vascular activity score (PETVAS), has been used to quantify the global inflammatory burden (22). PETVAS has also shown strong correlations with ITAS and the inflammatory biomarker pentraxin-3, as compared to CRP and ESR (23).…”

Pathophysiology, Diagnosis, and Management of Takayasu Arteritis: A Review of Current Advances

“…Various imaging modalities are utilized in the diagnosis and surveillance of TA (Table 1 ) [ 47 ]. Digital subtraction angiography (DSA) is considered the gold standard for diagnosis as it allows imaging of the coronary arteries and assessment of aortic pressure [ 48 ].…”