Abstract
Vasculitis, the inflammation of blood vessels, can produce devastating complications such as blindness, renal failure, aortic rupture and heart failure through a variety of end-organ effects. Noninvasive imaging with cardiovascular magnetic resonance (CMR) has contributed to improved and earlier diagnosis. CMR may also be used in serial evaluation of such patients as a marker of treatment response and as an indicator of subsequent complications. Unique strengths of CMR favoring its use in such conditions are its abilities to noninvasively visualize both lumen and vessel wall with high resolution. This case-based review focuses on the large- and medium-vessel vasculitides where MR angiography has the greatest utility. Because of increasing recognition of cardiac involvement in small-vessel vasculitides, this review also presents evidence supporting greater consideration of CMR to detect and quantify myocardial microvascular disease. CMR’s complementary role amidst traditional clinical, serological and other diagnostic techniques in personalized care for patients with vasculitis is emphasized. Specifically, the CMR laboratory can address questions related to extent and severity of vascular involvement. As ongoing basic and translational studies better elucidate poorly-defined underlying molecular mechanisms, this review concludes with a discussion of potential directions for the development of more targeted imaging approaches.
Highlights
Vasculitis, the inflammation of blood vessels, is rare [1,2], yet those affected may suffer high rates of morbidity and mortality
While this review focuses on the primary vasculitides, secondary vasculitis and mimics of vasculitis warrant consideration when evaluating a patient with suspected vasculitis [5]
Review and Conclusions Su and colleagues, in one of the few studies of molecular imaging targeting non-atherosclerotic vascular inflammation, showed feasibility of targeting the enzyme myeloperoxidase that is a marker of certain vasculitides [75]
Summary
Vasculitis, the inflammation of blood vessels, is rare [1,2], yet those affected may suffer high rates of morbidity and mortality. While advances in serologic testing have afforded somewhat earlier diagnosis, there remains a need for better techniques to detect vasculitis and improve outcomes. Advances in non-invasive imaging are poised to fill this gap, in vasculitis involving large- and medium-sized arteries where these studies can play a significant role in i) establishing the correct diagnosis, ii) determining disease extent and activity and iii) measuring treatment response [3]. Some clinicians may not consider CMR due to concerns surrounding the use of gadolinium-based contrast in vasculitis patients who frequently present with significant renal dysfunction.
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