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. 2004 Aug;63(8):995–1000. doi: 10.1136/ard.2003.015701

Non-invasive imaging in the diagnosis and management of Takayasu's arteritis

J Andrews 1, A Al-Nahhas 1, D Pennell 1, M Hossain 1, K Davies 1, D Haskard 1, J Mason 1
PMCID: PMC1755083  PMID: 15249328

Abstract

Objectives: Takayasu's arteritis (TA) is a rare disease, in which early diagnosis and assessment of treatment efficacy remain a problem. Signs and symptoms may be non-specific and conventional blood tests unreliable, with vascular inflammation often persisting in the face of a normal acute phase response. The current "gold standard" investigation, x ray angiography, is invasive and only identifies late, structural changes in vessels. Recently, non-invasive imaging methods have shown promise in the assessment of patients with TA.

Methods: The invasive and non-invasive imaging performed on all patients in the rheumatology department at the Hammersmith Hospital between May 1996 and May 2002 who fulfilled the ACR criteria for TA were reviewed. All patients were clinically active at diagnosis and were treated with high dose oral prednisolone and additional oral or intravenous immunosuppression.

Results: Non-invasive imaging methods ([18F]fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) and magnetic resonance imaging (MRI)) provided important additional information about disease activity ([18F]FDG-PET) and progression of vessel wall thickening (MRI) when compared with x ray angiography.

Conclusions: Non-invasive imaging methods provide useful additional information towards the diagnosis and management of TA. Such techniques may allow earlier diagnosis and more accurate assessment of response to treatment than conventional clinical assessment and/or angiography. Non-invasive imaging is likely to be useful in the management of other large vessel vasculitides.

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Figure 1.

Figure 1

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 (A) [18F]FDG-PET scan of patient 5 with active TA at diagnosis. Note the markedly abnormal uptake of [18F]FDG in the aortic arch and carotid arteries (arrows). (B) [18F]FDG-PET scan of the same patient in remission after treatment with prednisolone and intravenous cyclophosphamide. Note almost complete resolution of abnormal [18F]FDG uptake in these areas.

Figure 2.

Figure 2

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 (A) Magnetic resonance angiography (MRA) image from patient 5 with active TA at diagnosis. There is complete occlusion of the left subclavian artery at its origin (arrow) with numerous collaterals evident and an ostial stenosis of the left common carotid artery. (B) MRA image from the same patient in remission. No significant progression of the lesions found on the baseline MRA is seen.

Figure 3.

Figure 3

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 Coronary angiography image from patient number 5 with active TA at diagnosis. A tight stenosis can be seen at the origin of the left main stem coronary artery (arrow). Shortly after this image was recorded, she had a VF cardiac arrest and the left main stem was found to have occluded. After resuscitation, the left main stem was rapidly re-opened with the insertion of a coronary stent without further complication.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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