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Patterns of aortic involvement in Takayasu arteritis and its clinical implications: evaluation with spiral computed
Jin Wook Chung1, Hyo-Cheol Kim, Young Ho Choi
1Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Seoul, South Korea. chungjw@radcom.snu.ac.kr
Insights
Computed tomography (CT) angiography reveals extensive aortic and branch vessel involvement in Takayasu arteritis. Mural changes are often wider than luminal changes, with contiguous and skipped lesions, and active and inactive disease coexisting.
Area of Science:
- Vascular Medicine
- Radiology
- Immunology
Background:
- Takayasu arteritis is a large vessel vasculitis affecting the aorta and its branches.
- Conventional angiography visualizes luminal changes, but mural alterations are better assessed with CT angiography.
Purpose of the Study:
- To investigate the patterns of aortic involvement in Takayasu arteritis using CT angiography.
- To evaluate mural and luminal changes, disease extent, continuity, and activity.
Main Methods:
- CT angiography from carotid to iliac bifurcation in 85 Takayasu arteritis patients.
- Consensus interpretation by two radiologists of axial and 3D reconstructed images.
Main Results:
- 95% of patients had aortic and/or branch involvement; 5% had isolated branch involvement.
- Left common carotid and subclavian arteries were most commonly affected.
- Mural changes indicated wider disease extent than luminal changes in 61% of patients.
- Contiguous involvement occurred in 81%, skipped lesions in 19%.
- Active and inactive lesions coexisted in 11%.
Conclusions:
- Takayasu arteritis involves the aorta from root to iliac bifurcation, with possible isolated branch disease.
- Aortic involvement is typically contiguous and synchronous.
- Skipped lesions and mixed active/inactive disease patterns are also observed.
Objective:
Although the luminal changes of Takayasu arteritis are well depicted with conventional angiography, its mural changes can be best evaluated with spiral computed tomography (CT) angiography. Here, the authors investigated the patterns of aortic involvement in Takayasu arteritis by using CT angiography.
Methods:
CT angiography was performed from the carotid bifurcation to the iliac bifurcation in a consecutive 85 patients (M:F = 10:75, mean age: 37 years) with Takayasu arteritis. Two radiologists interpreted axial images and three-dimensional reconstructed images by consensus with respect to disease extent, lesion continuity, and disease activity based on mural and luminal changes on CT angiography.
Results:
Eighty-one (95%) patients had aortic involvement with or without aortic branch involvement, and the other four (5%) patients had only aortic branch involvement. In terms of aortic branches, the left common carotid artery (77%) and the left subclavian artery (76%) were most commonly involved. Extent of disease involvement assessed by mural change was wider than that assessed by luminal change in 52 (61%) patients. Although arterial involvement was contiguous in 69 (81%) patients, skipped lesions were identified in 16 (19%) patients. An analysis of mural findings revealed the coexistence of active and inactive lesions in nine (11%) patients.
Conclusions:
Aortic involvement in Takayasu arteritis can occur from the aortic root to below the iliac bifurcation, and isolated branch vessel involvement is also possible. In most patients, aortic involvement occurs in a contiguous, synchronous fashion. However, skipped involvement and the coexistence of active and inactive lesions also occur.
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