Abstract
To evaluate contrast-enhanced magnetic resonance angiography (MRA) in diagnosis of inflammatory aortic involvement in patients with clinical suspicion of large-vessel vasculitis. Seventy-five patients, mean age 62 years (range 16-82 years), 44 female and 31 male, underwent gadolinium-enhanced MRA and were evaluated retrospectively. Thoracic MRA was performed in 32 patients, abdominal MRA in 7 patients and both thoracic and abdominal MRA in 36 patients. Temporal arterial biopsies were obtained from 22/75 patients. MRA positivity was defined as increased aortic wall signal in late gadolinium-enhanced axial turbo inversion recovery magnitude (TIRM) series. The influence of prior glucocorticoid intake on MRA outcome was evaluated. MRA was positive in 24/75 patients, with lesions located in the thorax in 7 patients, the abdomen in 5 and in both thorax and abdomen in 12. Probability for positive MRA after glucocorticoid intake for more than 5 days before MRA was reduced by 89.3%. Histology was negative in 3/10 MRA-positive patients and positive in 5/12 MRA-negative patients. All 5/12 histology positive / MRA-negative patients had glucocorticoids for >5 days prior to MRA and were diagnosed as having vasculitis. Positive predictive value for MRA was 92%, negative predictive value was 88%. Contrast-enhanced MRA reliably identifies large vessel vasculitis. Vasculitic signals in MRA are very sensitive to glucocorticoids, suggesting that MRA should be done before glucocorticoid treatment.
Highlights
Giant-cell arteritis represents the most common form of large vessel vasculitis in people over the age of 50 years
Probability for positive magnetic resonance imaging of arteries (MRA) after glucocorticoid intake for more than 5 days before MRA was reduced by 89.3%
Vasculitic signals in MRA are very sensitive to glucocorticoids, suggesting that MRA should be done before glucocorticoid treatment
Summary
Giant-cell arteritis represents the most common form of large vessel vasculitis in people over the age of 50 years. The vasculitis counterpart in patients younger than 45 years of age is called Takayasu arteritis This form of large-vessel vasculitis typically affects branches of the aortic arch. Colour-coded ultrasound of extracranial arteries yields good specificity and sensitivity when compared with fluorodeoxy-glucose positron emission tomography (FDG-PET) [6], Even so, large vessel inflammation can be missed owing to technical limitations of ultrasound transducer devices [7]. Other imaging techniques, such as contrast-guided computed tomography angiography (CTA), have shown good results but carry the risk of contrast and radiation exposure, and might miss early inflammation [8]. Mostly consisting of glucocorticoids, can suppress clinical symptoms
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
