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Use of imaging studies in the diagnosis of vasculitis

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Abstract

Imaging studies are necessary to determine disease extension and disease activity in the small-vessel vasculitides. Computed tomography (CT) and magnetic resonance imaging (MRI) increase the number of pathologic findings compared with conventional radiography. MRI delineates mucosal inflammation and granulomas in the paranasal sinuses, whereas CT provides information about osseous lesions. CT is superior to MRI for the detection of pulmonary lesions. Radiograph angiography has been the gold standard for medium- and large-vessel vasculitides for decades. Echocardiography and MRI correspond well with conventional angiography to assess cardiac involvement in Kawasaki disease. MRI, CT, and CT angiography are alternative noninvasive techniques to delineate vasculitic lesions in polyarteritis nodosa, Takayasu’s arteritis, and large-vessel giant cell arteritis. Duplex ultrasonography has the greatest resolution. It delineates typical artery wall swelling in temporal arteritis and Takayasu’s arteritis. Positron emission tomography can assess inflammatory activity of large arteries.

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Konstanze Viktoria Guggenberger & Thorsten Alexander Bley

References and Recommended Reading

  1. Komocsi A, Reuter M, Heller M, et al.: Active disease and residual damage in treated Wegener’s granulomatosis: an observational study using pulmonary high-resolution computed tomography. Eur Radiol 2003, 13:36–42.

    PubMed  Google Scholar 

  2. Lee KS, Kim TS, Fujimoto K, et al.: Thoracic manifestation of Wegener’s granulomatosis: CT findings in 30 patients. Eur Radiol 2003, 13:43–51.

    Article  PubMed  Google Scholar 

  3. Lloyd G, Lund VJ, Beale T, Howard D: Rhinologic changes in Wegener’s granulomatosis. J Laryngol Otol 2002, 116:565–569.

    Article  PubMed  Google Scholar 

  4. Warnatz K, Peter HH, Schumacher M, et al.: Infectious CNS disease as a differential diagnosis in systemic rheumatic diseases: three case reports and a review of the literature. Ann Rheum Dis 2003, 62:50–57.

    Article  PubMed  CAS  Google Scholar 

  5. Schmidt WA, Seipelt E, Molsen HP, et al.: Vasculitis of the internal carotid artery in Wegener’s granulomatosis: comparison of ultrasonography, angiography, and MRI. Scand J Rheumatol 2001, 30:48–50.

    Article  PubMed  CAS  Google Scholar 

  6. Choi YH, Im JG, Han BK, et al.: Thoracic manifestation of Churg-Strauss syndrome: radiologic and clinical findings. Chest 2000, 117:117–124.

    Article  PubMed  CAS  Google Scholar 

  7. Diagnostic guidelines for Kawasaki disease.Circulation 2001, 103:335–336. Concise new diagnostic guidelines with clinical, echocardiographic, and angiographic images.

  8. Gedalia A: Kawasaki disease: an update. Curr Rheumatol Rep 2002, 4:25–29.

    Article  PubMed  Google Scholar 

  9. Moran AM, Newburger JW, Sanders SP, et al.: Abnormal myocardial mechanics in Kawasaki disease: rapid response to gamma-globulin. Am Heart J 2000, 139:217–223. The authors investigated 25 children with acute Kawasaki disease. In addition, they performed several follow-up investigations for 1 year.

    PubMed  CAS  Google Scholar 

  10. Hiraishi S, Misawa H, Takeda N, et al.: Transthoracic ultrasonic visualisation of coronary aneurysm, stenosis, and occlusion in Kawasaki disease. Heart 2000, 83:400–405. This study determines the sensitivity and specificity for echocardiography compared with angiography in 60 patients with Kawasaki disease.

    Article  PubMed  CAS  Google Scholar 

  11. Ravekes WJ, Colan SD, Gauvreau K, et al.: Aortic root dilation in Kawasaki disease. Am J Cardiol 2001, 87:919–922. Retrospective study of 100 patients with Kawasaki disease and 179 control subjects. The aortic root dimension was increased in Kawasaki disease, and four patients developed mild aortic regurgitation after 1 year compared with the control subjects.

    Article  PubMed  CAS  Google Scholar 

  12. Ishii M, Ueno T, Ikeda H, et al.: Sequential follow-up results of catheter intervention for coronary artery lesions after Kawasaki disease: quantitative coronary artery angiography and intravascular ultrasound imaging study. Circulation 2002, 105:3004–3010.

    Article  PubMed  Google Scholar 

  13. Greil GF, Stuber M, Botnar RM, et al.: Coronary magnetic resonance angiography in adolescents and young adults with Kawasaki disease. Circulation 2002, 105:908–911.

    Article  PubMed  Google Scholar 

  14. Sohn S, Kim HS, Lee SW: Multidetector row computed tomography for follow-up of patients with coronary artery aneurysms due to Kawasaki disease. Pediatr Cardiol 2003, in press.

  15. Schratz LM, Meyer RA, Schwartz DC: Serial intracoronary ultrasound in children: feasibility, reproducibility, limitations, and safety. J Am Soc Echocardiogr 2002, 15:782–790.

    Article  PubMed  Google Scholar 

  16. Kahwaji IY, Connuck DM, Tafari N, Dahdah NS: A national survey on the pediatric cardiologist’s clinical approach for patients with Kawasaki disease. Pediatr Cardiol 2002, 23:639–646. This study investigated the opinion of 97 of 350 US pediatric cardiologists with regard to diagnostic and management issues of Kawasaki disease.

    Article  PubMed  CAS  Google Scholar 

  17. McMorrow-Tuohy AM, Tani LY, Cetta F, et al.: How many echocardiograms are necessary for follow-up evaluation of patients with Kawasaki disease? Am J Cardiol 2001, 88:328–330.

    Article  PubMed  CAS  Google Scholar 

  18. Furuyama H, Odagawa Y, Katoh C, et al.: Altered myocardial flow reserve and endothelial function late after Kawasaki disease. J Pediatr 2003, 142:149–154.

    Article  PubMed  Google Scholar 

  19. Hiraishi S, Hirota H, Horiguchi Y, et al.: Transthoracic Doppler assessment of coronary flow velocity reserve in children with Kawasaki disease: comparison with coronary angiography and thallium-201 imaging. J Am Coll Cardiol 2002, 40:1816–1824.

    Article  PubMed  Google Scholar 

  20. Tashiro N, Matsubara T, Uchida M, et al.: Ultrasonographic evaluation of cervical lymph nodes in Kawasaki disease. Pediatrics 2002, 109:E77–79.

    Article  PubMed  Google Scholar 

  21. Miller DL: Angiography in polyarteritis nodosa. AJR Am J Roentgenol 2000, 175:1747–1748. Letter that briefly describes the pathogenesis of aneurysm development in polyarteritis nodosa. The author emphasizes that the angiographic finding of aneurysms is not specific for polyarteritis nodosa.

    PubMed  CAS  Google Scholar 

  22. Stanson AW, Friese JL, Johnson CM, et al.: Polyarteritis nodosa: spectrum of angiographic findings. Radiographics 2001, 21:151–159.

    PubMed  CAS  Google Scholar 

  23. Levine SM, Hellmann DB, Stone JH: Gastrointestinal involvement in polyarteritis nodosa (1986-2000): presentation and outcomes in 24 patients. Am J Med, 2002, 112:386–391.

    Article  PubMed  Google Scholar 

  24. Gallien S, Mahr A, Rety F, et al.: Magnetic resonance imaging of skeletal muscle involvement in limb restricted vasculitis. Ann Rheum Dis 2002, 61:1107–1109.

    Article  PubMed  CAS  Google Scholar 

  25. Hughes LB, Bridges SL Jr.: Polyarteritis nodosa and microscopic polyangiitis: etiologic and diagnostic considerations. Curr Rheumatol Rep 2002, 4:75–82.

    Article  PubMed  Google Scholar 

  26. Schmidt WA, Gromnica-Ihle E: Incidence of temporal arteritis in patients with polymyalgia rheumatica: a prospective study using colour Doppler ultrasonography of the temporal arteries. Rheumatology 2002, 41:46–52. Temporal artery duplex ultrasonography was performed in consecutive patients with 201C;ralgia rheumatica to detect some patients with accompanying temporal arteritis.

    Article  PubMed  CAS  Google Scholar 

  27. LeSar CJ, Meier GH, DeMasi RJ, et al.: The utility of color duplex ultrasonography in the diagnosis of temporal arteritis. J Vasc Surg 2002, 36:1154–1160.

    Article  PubMed  Google Scholar 

  28. Murgatroyd H, Nimmo M, Evans A, MacEwen C: The use of ultrasound as an aid in the diagnosis of giant cell arteritis: a pilot study comparing histological features with ultrasound findings. Eye 2000, 17:415–419.

    Article  Google Scholar 

  29. Nesher G, Shemesh D, Mates M, et al.: The predictive value of the halo sign in color Doppler sonography of the temporal arteries for diagnosing giant cell arteritis. J Rheumatol 2002, 29:1224–1226.

    PubMed  Google Scholar 

  30. Pfadenhauer K, Weber H: Duplex sonography of the temporal and occipital artery in the diagnosis of temporal arteritis: a prospective study. J Rheumatol 2003, 30:2177–2281.

    PubMed  Google Scholar 

  31. Roters S, Szurman P, Engels BF, Brunner R: The suitability of the ultrasound biomicroscope for establishing texture in giant-cell arteritis. Br J Ophthalmol 2001, 85:946–948.

    Article  PubMed  CAS  Google Scholar 

  32. Salvarani C, Silingardi M, Ghirarduzzi A, et al.: Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis? Ann Intern Med 2002, 137:232–238.

    PubMed  Google Scholar 

  33. Schmidt D, Hetzel A, Reinhard M, Auw-Haedrich C: Comparison between color duplex ultrasonography and histology of the temporal artery in cranial arteritis (giant cell arteritis). Eur J Med Res 2003, 8:1–7.

    PubMed  Google Scholar 

  34. Schmidt WA, Gromnica-Ihle E: Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis? Ann Int Med 2003, 138:609. Letter that describes the sensitivity and specificity of the greatest number of investigated patients.

    PubMed  Google Scholar 

  35. Granel B, Serratrice J, Ene N, et al.: Juvenile temporal arteritis and activated protein C resistance. Ann Rheum Dis 2004, 63:215–216.

    Article  PubMed  CAS  Google Scholar 

  36. Schmidt WA, Natusch A, Möller DE, et al.: Involvement of peripheral arteries in giant cell arteritis: a color Doppler sonography study. Clin Exp Rheumatol 2002, 20:309–318.

    PubMed  CAS  Google Scholar 

  37. Reitblat T, Ben-Horin C, Reitblat A: Gallium-67 SPECT scintigraphy may be useful in diagnosis of temporal arteritis. Ann Rheum Dis 2003, 62:257–260.

    Article  PubMed  CAS  Google Scholar 

  38. Blockmans D, Stroobants S, Maes A, Mortelmans L: Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med 2000, 108:246–249. The authors investigated 69 consecutive patients with suspected temporal arteritis or polymyalgia rheumatica with PET. Increased 18-fluorodeoxyglucose uptake in the thoracic aorta occurred in 13 of 25 patients with established diagnosis of temporal arteritis or polymyalgia rheumatica, but only in one of 44 control subjects in whom no temporal arteritis or polymyalgia rheumatica were found.

    Article  PubMed  CAS  Google Scholar 

  39. Meller J, Strutz F, Siefker U, et al.: Early diagnosis and followup of aortitis with [(18)F]FDG PET and MRI. Eur J Nucl Med Mol Imaging 2003, 30:730–736.

    Article  PubMed  CAS  Google Scholar 

  40. Stanson AW: Imaging findings in extracranial (giant cell) temporal arteritis. Clin Exp Rheumatol 2000, 18(suppl):S43-S48.

    PubMed  CAS  Google Scholar 

  41. Kissin EY, Merkel PA: Diagnostic imaging in Takayasu arteritis. Curr Opin Rheumatol 2004, 16:31–37. This publication provides a systematic review on advantages and disadvantages of MRI, MRA, duplex ultrasnonography, CT, and PET to diagnose Takayasu’s arteritis. It provides many typical images.

    Article  PubMed  Google Scholar 

  42. Endo M, Tomizawa Y, Nishida H, et al.: Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis. J Thorac Cardiovasc Surg 2003, 125:570–577.

    Article  PubMed  Google Scholar 

  43. Atalay MK, Bluemke DA: Magnetic resonance imaging of large vessel vasculitis. Curr Opin Rheumatol 2001, 13:41–47. This review describes the technique of MRI and MRA for large-vessel vasculitis and provides several images.

    Article  PubMed  CAS  Google Scholar 

  44. Yamada I, Nakagawa T, Himeno Y, et al.: Takayasu arteritis: diagnosis with breath-hold contrast-enhanced threedimensional MR angiography. J Magn Reson Imaging 2000, 11:481–487. This is a study that compares radiograph angiography with MRA. The results of these imaging techniques corresponded very well. MRA tends to overestimate stenoses.

    Article  PubMed  CAS  Google Scholar 

  45. Tso E, Flamm SD, White RD, et al.: Takayasu arteritis: utility and limitations of magnetic resonance imaging in diagnosis and treatment. Arthritis Rheum 2002, 46:1634–1642. This study compares MRA and radiograph angiography with the clinical and laboratory test status with respect to disease activity. The authors conclude that inconsistencies in the presence or absence of artery wall edema and subsequent anatomic changes have cast doubt on the utility of edema-weighted MRI as a sole guide to disease activity and treatment in Takayasu’s arteritis.

    Article  PubMed  Google Scholar 

  46. Lefebvre C, Rance A, Paul JF, et al.: The role of B-mode ultrasonography and electron beam computed tomography in evaluation of Takayasu’s arteritis: a study of 43 patients. Semin Arthritis Rheum 2000, 30:25–32.

    Article  PubMed  CAS  Google Scholar 

  47. Raninen RO, Kupari MM, Hekali PE: Carotid and femoral artery stiffness in Takayasu’s arteritis: an ultrasound study. Scand J Rheumatol 2002, 31:85–88.

    Article  PubMed  Google Scholar 

  48. Schmidt WA, Nerenheim A, Seipelt E, et al.: Diagnosis of early Takayasu arteritis by colour Doppler ultrasonography. Rheumatology 2002, 41:496–502.

    Article  PubMed  CAS  Google Scholar 

  49. Park S, Chung J, Lee J: Carotid artery involvement in Takayasu’s arteritis: evaluation of the activity by ultrasonography. J Ultrasound Med 2001, 20:371–378.

    PubMed  CAS  Google Scholar 

  50. Cantu C, Pineda C, Barinagarrementeria F, et al.: Noninvasive cerebrovascular assessment of Takayasu arteritis. Stroke 2000, 31:2197–2202.

    PubMed  CAS  Google Scholar 

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Schmidt, W.A. Use of imaging studies in the diagnosis of vasculitis. Curr Rheumatol Rep 6, 203–211 (2004). https://doi.org/10.1007/s11926-004-0069-1

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