eMedicine Specialties > Radiology > Vascular/Interventional

Arteritis, Takayasu: Imaging

Author: Robert L Cirillo Jr, MD, MBA, Assistant Professor of Radiology, Florida State University College of Medicine; Medical Interventional Radiologist, Director/CEO, South Georgia Vascular Institute and South Georgia Laser Vein Center
Contributor Information and Disclosures

Updated: Sep 10, 2008

Computed Tomography

Findings

Contrast-enhanced CTA may demonstrate thickening of the arterial wall with crescents and indistinct outlines. Multidetector-row CT now allows faster scanning at higher resolutions with large fields of view; these factors increase the diagnostic value of the tool. The utility of this noninvasive technique is particularly high in pediatric patients, in whom the complications of angiography are potentially worse than they are in adults.15,16

One disadvantage of CTA is that pressure differentials cannot be measured across lesions in which imaging findings regarding their hemodynamic significance are inconclusive.

Magnetic Resonance Imaging

Findings

In cases of Takayasu arteritis, gadolinium-enhanced MRA may demonstrate thickening of the arterial wall with crescents and indistinct outlines. The utility of this noninvasive technique is particularly high in pediatric patients in whom the complications of angiography are potentially greater than in adults.17,18,19,14,20,21

The soft tissue differentiation obtained with MR techniques may help distinguish the active or acute phase from the chronic phase of the disease. This capability may be important in the timing of catheter-based or other interventions.

One disadvantage of MRA is that pressure differentials cannot be measured across lesions in which imaging findings regarding their hemodynamic significance are inconclusive.

Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the eMedicine topic Nephrogenic Fibrosing Dermopathy.

NSF/NFD has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans. NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory or Medscape.

Ultrasonography

Findings

Sonography may depict vascular stenoses in accessible areas; their location may suggest the diagnosis of Takayasu arteritis.

Degree of Confidence

The negative predictive value of a sonographic finding in establishing or excluding the diagnosis of Takayasu disease is insufficient.

Angiography

Findings

Angiography is a useful imaging modality in the detection of Takayasu arteritis. Because of its invasiveness, angiography is not the first-line study in most patients, particularly pediatric patients. Gadolinium-enhanced MRA findings may be diagnostic or strongly suggestive of the disease (see Images 1-3).22

Aortography reveals focal, smooth, symmetric narrowing of the aorta and multiple branch-vessel stenosis or occlusion. Stenosis is the most common finding, although arterial dilatation and aneurysms are often found. When Takayasu disease involves the subclavian artery, the lesion is a smoothly tapered stenosis; it begins within a few centimeters of the arch and extends to the origin of the vertebral artery. The lesions are often multiple and symmetric.

Serial angiography is helpful in the initial diagnosis and follow-up of patients with Takayasu arteritis. Pressure measurements should be obtained in the ascending aorta and compared with measurements in the extremities.

In 75% of patients, the sites of vascular involvement include the aortic arch and its branches. The most commonly involved aortic branches are the left subclavian artery, which is affected in 55% of patients, followed by the right subclavian artery (38%), the left common carotid artery (30%), and the right common carotid artery (15%).

More on Arteritis, Takayasu

Overview: Arteritis, Takayasu
Imaging: Arteritis, Takayasu
Follow-up: Arteritis, Takayasu
Multimedia: Arteritis, Takayasu
References
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References

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Further Reading

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Keywords

Takayasu arteritis, Takayasu's arteritis, Takayasu disease, Takayasu's disease, nonspecific aortoarteritis, pulseless disease, aortic arch syndrome, granulomatous vasculitis, aortic inflammation

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Contributor Information and Disclosures

Author

Robert L Cirillo Jr, MD, MBA, Assistant Professor of Radiology, Florida State University College of Medicine; Medical Interventional Radiologist, Director/CEO, South Georgia Vascular Institute and South Georgia Laser Vein Center
Robert L Cirillo Jr, MD, MBA is a member of the following medical societies: American College of Physician Executives, Cardiovascular and Interventional Radiological Society of Europe, Society for Vascular Technology, and Society of Interventional Radiology
Disclosure: Nothing to disclose.

Medical Editor

Anthony Watkinson, MD, Professor of Interventional Radiology, The Peninsula Medical School; Consultant and Senior Lecturer, Department of Radiology, The Royal Devon and Exeter Hospital, UK
Anthony Watkinson, MD is a member of the following medical societies: Radiological Society of North America, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Douglas M Coldwell, MD, PhD,, Principal, Coldwell Associates. Interventional Radiologist, Jane Phillips Medical Center, Bartlesville, OK
Douglas M Coldwell, MD, PhD, is a member of the following medical societies: American Association for Cancer Research, American College of Radiology, American Heart Association, American Physical Society, American Roentgen Ray Society, Society of Cardiovascular and Interventional Radiology, Southwest Oncology Group, and Special Operations Medical Association
Disclosure: Sirtex, Inc. Consulting fee Speaking and teaching

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Kyung J Cho, MD, FACR, William Martel Professor of Radiology, Interventional Radiology Fellowship Director, University of Michigan Health System
Kyung J Cho, MD, FACR is a member of the following medical societies: American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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