Abstract
AimsTo assess the value of contrast-enhanced ultrasonography (CEUS) for monitoring disease activity of Takayasu arteritis (TA).MethodsTA patients were recruited in a Chinese TA clinical center from January 2016 to September 2017. The physician global assessment was used as the referential standard for disease activity. Clinical data, acute phase reactants, and CEUS scans were simultaneously recorded at baseline and after a 3-month therapy.ResultsA total of 84 TA patients were enrolled, and 47 (55.95%) cases were active at baseline. Macaroni sign and entire artery involvement were characteristic findings of CEUS in TA. The average vascular full thickness of the carotid artery in active TA patients was significantly higher than that in inactive patients (2.36 ± 0.86 vs. 1.79 ± 0.49 mm; p = 0.001). Severe neovascularization (grade 2) was observed in 29 active cases (61.70%) and in 9 inactive cases (24.32%) (p = 0.001). Receiver operating characteristic analysis showed that the combination of CEUS parameters (cutoff of thickness was 1.75 mm or neovascularization grade 2) and erythrocyte sedimentation rate (ESR) (cutoff of 20 mm/H) could help differentiate between active and inactive TA patients with a sensitivity and specificity of 81.1% and 81.5%, respectively. Youdon’s index was 0.626. Furthermore, our study found that patients with decreased ESR and C-reactive protein (CRP) still had a progression of vascular wall inflammation at 3 months of follow-up.ConclusionsThe evaluation of vascular inflammation by CEUS is more sensitive than acute phase reactants. Neovascularization can still be observed in the vascular lesion sites of those who have reached clinical remission after treatment. Thus, CEUS can be used as an alternative method to assess disease activity for TA patients.
Highlights
Takayasu arteritis (TA) is a type of chronic inflammatory vasculitis that develops mainly in Asian women of childbearing age
Imaging tests were done in all the patients including computed tomography angiography (CTA) (4 cases), vascular ultrasound (20 cases), or Magnetic resonance angiography (MRA) (78 cases)
For better predicting disease activity, we conducted a serial test using the above combined contrast-enhanced ultrasonography (CEUS) parameters and erythrocyte sedimentation rate (ESR), the results demonstrated a sensitivity of 81.1% and specificity of 81.5% and the positive likelihood ratio and negative likelihood ratio were 4.38 and 0.23 respectively with area under the curve (AUC) of 0.848
Summary
Takayasu arteritis (TA) is a type of chronic inflammatory vasculitis that develops mainly in Asian women of childbearing age. The condition primarily involves the aorta and its branches, as well as the ascending aorta, abdominal aorta, renal artery, and pulmonary artery. Pathological data suggest that inflammation progresses from the adventitia to the intima and eventually encompasses the whole layer, leading to stenosis, occlusion, or expansion and to organ ischemia and infarction. Once TA is diagnosed, comprehensive disease assessments, including disease activity, vascular stenosis, organ function, and drug-related adverse events, should be conducted to guide the therapeutic strategy. Up to date, the biggest challenge is the lack of quantitative, reliable, and effective measures to monitor disease activity in TA. Ma et al Arthritis Research & Therapy (2019) 21:24
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