Brain computed tomography perfusion alterations in patients with Takayasu arteritis with steno-occlusive carotid...

Data on computed tomography perfusion (CTP) in Takayasu arteritis (TAK) patients are limited. Herein, we used CTP combined with computed tomography angiography (CTA) to investigate the brain hemodynamic status in TAK patients with stenosis/occlusive carotid arteries.

We retrospectively analyzed 49 TAK patients with carotid artery stenosis or occlusion who had ischemic manifestations and completed a one-stop aortic CTA and brain CTP at Xijing Hospital between 2021 and 2023. Hemodynamic parameters, including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to maximum (Tmax), were compared between groups using independent samples t-test or the Mann-Whitney U test. Relationships among CTP parameters and disease activity were evaluated by correlation analyses.

Among 49 patients (43 females; age 38.7 ± 11.1 years), 15 had common carotid artery occlusion (four bilateral, six right, and five left). Compared with the non-occlusion group, the occlusion group had longer MTT and Tmax (p < 0.05) but showed no differences in CBV and CBF values. Patients with different degrees of lesions on two sides of the carotid artery (n = 31) had lower mean CBF on the severely affected side than on the contralateral side (p = 0.022). In contrast, mean MTT (p = 0.036) and Tmax (p = 0.024) were longer. Patients with more severe ischemic symptoms had longer Tmax than patients with mild symptoms (p < 0.05). Tmax was moderately correlated with disease activity indices (p < 0.05).

Alterations in cerebral hemodynamic perfusion were observed in TAK patients. The implications of these findings in evaluating brain ischemia and dysfunction require further investigation. Key Points • Alterations in cerebral hemodynamic perfusion were observed in TAK patients. • Compared with patients without common carotid artery occlusion, patients with occlusion had longer MTT and Tmax values. • In patients with different degrees of lesions on the two sides of the carotid artery, the severely affected side had a lower CBF and prolonged MTT and Tmax than the contralateral side. • Patients with moderate-to-severe ischemic manifestations had a longer Tmax than patients with mild symptoms, and MTT and Tmax correlated with disease activity indices.