TAKAYASU'S ARTERITIS: UTILITY OF MAGNETIC RESONANCE
IMAGING IN DIAGNOSIS AND TREATMENT.G S Hoffman, E Tso, R D
White, S D Flamm. Cleveland, OH, Cleveland, OH.
Background: Previous studies have emphasized that symptoms,
signs and acute phase reactants fail to correlate with histologic
or angiographic evidence of active disease in up to 1/2 of
patients (pts) with Takayasu’s arteritis (TA). Assessment of TA
progression by sequential invasive angiography studies exposes pts
to high dose ionizing radiation and may produce vascular injury.
Such studies also do not provide qualitative information about the
vascular wall re: thickness or inflammation. We have utilized MR
with “edema-weighted”, ECG-gated images, to detect vessel
inflammation (image enhancement) in 77 studies of 24 TA pts. Methods: Prospective. Inclusion criteria: age<40,
clinical and invasive-angiographic features of TA. Stratification
of pts based on: I. Unequivocal active disease (systemic features,
worsening ischemia or aneurysm formation); II. Inactive disease;
III. Status uncertain.
Results:
Clinical
Assessment
(# cases)
ESR
or CRP (%)
MR Enhancement
(%) Total
MR Enhancement
in Pts with ESR
or CRP (%)
I. Active
19
53
79
8/9 (89)
II. Inactive
44
29
34
6/12 (50)
III. Uncertain
14
33
43
2/4 (50)
Conclusion: Care for patients with TA has been confounded
by recognition of histologic and angiographic evidence of active
disease in 40-60% of pts who clinically appear to be in remission.
It is difficult to determine the precise accuracy of any
non-surgical technique, including MR, to assess TA disease
activity because routine study of vascular histopathology is not
feasible. Nonetheless, in our experience, edema-weighted MR has
been a useful adjunct to clinical assessment.
Disclosure:
Keywords: Takayasu's Arteritis; Magnetic Resonance Imaging
Presentation Date: Sunday, November 14, 1999, Time: 4:00PM, Room:
Ballroom C
[845] THE SIGNIFICANCE OF RIB NOTCHING IN TAKAYASU ARTERITIS.
A CASE-CONTROL STUDY.C Pineda, J Coindreau, J Vazquez, A
Nava, M Martinez-Lavin. Mexico City, Mexico.
Rib notching (Roesler sign) have been occasionally identified in
chest radiographs of Takayasu arteritis (TA) patients, its
significance and importance remain unknown. Objective: to
elucidate the relevance of this x-ray finding and to identify
associated factors. Setting: a tertiary referral medical
center. Design: a cross-sectional, case-control study. Statistics:
Student's t test, Fisher's exact test, odds ratio (OR) and
95% confidence interval (Cl). Patients: Thirteen TA
patients who displayed rib erosions in chest radiographs were
considered as cases, and 28 TA patients with no rib notching were
included as controls. Both, cases and controls fulfilled the ACR
criteria for classification of TA, furthermore; the diagnosis was
corroborated by panaortoarteriography in all subjects. Method:
aortographies and chest radiographs were evaluated by an
experienced radiologist. The following data were analyzed: rib
notching location and distribution, presence and level of maximum
aortic stenosis or obstruction, subclavian arteries involvement,
collateral blood flow and intercostal artery angiographic
abnormalities. In addition, aortic pressure gradients were
calculated when appropriate. Results: there were 13 cases
and 28 controls. The mean age of the cases and controls (29 yrs vs
26), male/female ratio (3/10 vs 2/26), and disease duration (69
months vs 80) did not reach statistical difference. Unilateral rib
notching was present in 6 cases (46%) and bilaterally in 7 cases
(54%). Erosions were distributed between the third and the tenth
ribs, and located in the inferior aspect of its posterior segment.
Ten cases (77%) and 2 controls (7%) displayed a critical stenosis
(>70% of luminal narrowing) or total occlusion of the thoracic
aorta (p<0.0001, OR = 43.3 and Cl: 6.2-299.3), a mean gradient
of 67.5 mm Hg was found across the maximum narrowed segment.
Erosions took place both, above and below the maximum stenotic
segment and were present in sites of extreme dilation and
tortuosity of the intercostal arteries. Conclusions: To
presence of rib notching in TA is strongly associated with
critical stenosis or occlusion of the thoracic aorta and may be a
consequence of an increased intercostal blood flow bypassing the
aortic constriction.
Disclosure:
Keywords: Takayasu's Arteritis
ACR Poster Session C: Vasculitis I (8:00 AM-9:30 AM)
Presentation Date: Monday, November 15, 1999, Time: 8:00AM, Room:
Hall C