Abstract
In large-vessel vasculitides, inflammatory infiltrates may cause thickening of the involved arterial vessel wall leading to progressive stenosis and occlusion. Dilatation, aneurysm formation, and thrombosis may also ensue. Activated macrophages and T lymphocytes are fundamental elements in vascular inflammation. The amount and density of the inflammatory infiltrate is directly linked to local disease activity. Additionally, patients with autoimmune disorders have an increased cardiovascular (CV) risk compared with age-matched healthy individuals as a consequence of accelerated atherosclerosis. Molecular imaging techniques targeting activated macrophages, neovascularization, or increased cellular metabolic activity can represent effective means of non-invasive detection of vascular inflammation. In the present review, novel non-invasive imaging tools that have been successfully tested in humans will be presented. These include contrast-enhanced ultrasonography, which allows detection of neovessels within the wall of inflamed arteries; contrast-enhanced CV magnetic resonance that can detect increased thickness of the arterial wall, usually associated with edema, or mural enhancement using T2 and post-contrast T1-weighted sequences, respectively; and positron emission tomography associated with radio-tracers such as [18F]-fluorodeoxyglucose and the new [11C]-PK11195 in combination with computed tomography angiography to detect activated macrophages within the vessel wall. Imaging techniques are useful in the diagnostic work-up of large- and medium-vessel vasculitides, to monitor disease activity and the response to treatments. Finally, molecular imaging targets can provide new clues about the pathogenesis and evolution of immune-mediated disorders involving arterial vessels.
Highlights
Vasculitides are conditions defined by the presence of inflammation of the vessel wall, with progressive alteration of the lumen, including lumen stenosis, occlusion, or even aneurysmal dilation
They can be broadly divided into infectious vasculitides, characterized by direct invasion of pathogens in the vessel wall and non-infectious vasculitides
Imaging techniques are useful to diagnose and monitor large-vessel vasculitides (LVV), they can play a role in the work-up of medium-vessel vasculitides, classically represented by polyarteritis nodosa (PAN) in www.frontiersin.org
Summary
Vasculitides are conditions defined by the presence of inflammation of the vessel wall, with progressive alteration of the lumen, including lumen stenosis, occlusion, or even aneurysmal dilation. GCA occurs more frequently in older adults, showing a predilection for the temporal artery and other extracranial vessels [4] Clinical manifestation of this disease ranges from ischemic symptoms and signs (such as jaws claudication) to aneurysmal rupture [4, 5]. Different classification criteria for LVV have been defined, and all of them are based upon clinical presentation, evidence of inflammation, and vascular abnormalities [6,7,8] They have proven largely unsatisfactory for diagnostic purposes [9, 10], frequently leading to delayed diagnosis [11]. Imaging techniques are useful to diagnose and monitor LVV, they can play a role in the work-up of medium-vessel vasculitides, classically represented by polyarteritis nodosa (PAN) in www.frontiersin.org
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