磁共振血管造影和多排 CT 血管造影在 Takayasu 动脉炎诊断中的应用：疾病程度评估及其与疾病活动的相关性。

Magnetic Resonance Angiography and Multidetector CT Angiography in the Diagnosis of Takayasu's Arteritis: Assessment of Disease Extent and Correlation with Disease Activity.

机构信息

Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya 793018, India.

Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India.

出版信息

Curr Med Imaging. 2022;18(1):51-60. doi: 10.2174/1573405617666210707154059.

DOI:10.2174/1573405617666210707154059

PMID:34238165

Abstract

BACKGROUND

Takayasu's Arteritis (TA) is a large vessel vasculitis with diverse clinical presentations and arterial vascular bed involvement.It is characterized by chronic, nonspecific inflammation of all layers of the vessel wall which results in stenosis, occlusion, dilatation, or aneurysm formation in the involved blood vessels.

METHODS

The study included 36 patients of TA. All patients fulfilled the modified Ishikawa's diagnostic criteria for TA. All patients were evaluated for clinical presentation, angiographic findings, and severity of the disease. The disease activity was assessed based on Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) and also by CT Angiography (CTA)/Magnetic resonance angiography (MRA) imaging. The angiographic types were classified based on the International TA Conference in Tokyo 1994 angiographic classification.

RESULTS

A total of 36 patients were included in the study, 86% were females and a mean age of 21.6 years. Hypertension (78%) was the most common clinical presentation. Type V was the most common angiographic type (42%) followed by type III (25%), type IV (14%), type IIb (11%), type I (5%) and type IIa (3%). Among the aortic arch branches the left subclavian artery (50%), right subclavian artery (38.8%), left vertebral artery (33.3%) and left common carotid artery (27.7%) were the most commonly involved arteries. Disease activity based on CT / MR imaging showed a significant statistical correlation with elevated ESR and positive CRP (p < 0.0001). Mediastinal lymphadenopathy was seen in 21 patients out of which 11 had active disease. However, no significant correlation was found between mediastinal lymphadenopathy and disease activity.

CONCLUSION

TA presents with varied symptomatology and differing vascular involvement. CT/MR angiography is effective in diagnosis and accurately predicted the active stage of the disease.

摘要

背景

Takayasu 动脉炎（TA）是一种大血管血管炎，具有多种临床表现和动脉血管床受累。其特征是血管壁各层的慢性、非特异性炎症，导致受累血管出现狭窄、闭塞、扩张或形成动脉瘤。

方法

本研究纳入 36 例 TA 患者。所有患者均符合改良 Ishikawa 的 TA 诊断标准。所有患者均进行临床表现、血管造影表现和疾病严重程度评估。根据红细胞沉降率（ESR）和 C 反应蛋白（CRP）以及 CT 血管造影（CTA）/磁共振血管造影（MRA）评估疾病活动度。根据 1994 年东京国际 TA 会议的血管造影分类对血管造影类型进行分类。

结果

本研究共纳入 36 例患者，86%为女性，平均年龄为 21.6 岁。高血压（78%）是最常见的临床表现。V 型是最常见的血管造影类型（42%），其次是 III 型（25%）、IV 型（14%）、IIb 型（11%）、I 型（5%）和 IIa 型（3%）。在主动脉弓分支中，左锁骨下动脉（50%）、右锁骨下动脉（38.8%）、左椎动脉（33.3%）和左颈总动脉（27.7%）是最常受累的动脉。基于 CT/MR 成像的疾病活动度与 ESR 升高和 CRP 阳性呈显著统计学相关性（p<0.0001）。21 例患者中发现纵隔淋巴结肿大，其中 11 例有活动性疾病。然而，纵隔淋巴结肿大与疾病活动度之间未发现显著相关性。