Title:Magnetic Resonance Angiography and Multidetector CT Angiography in the Diagnosis of Takayasu's Arteritis: Assessment of Disease Extent and Correlation with Disease Activity
Volume: 18
Author(s): Kalyan Sarma*, Akash Handique, Pranjal Phukan , C. Daniala, Happy Chutia and Bhupen Barman*
Affiliation:
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences
(NEIGRIHMS), Shillong, Meghalaya 793018, India
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India
Keywords:
Takayasu’s arteritis, Multidetector CT angiography (CTA), magnetic resonance angiography (MRA), disease activity, North East India, CT/MR.
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.
