Korean J Radiol.  2007 Aug;8(4):286-294. 10.3348/kjr.2007.8.4.286.

Follow-up CT Evaluation of the Mural Changes in Active Takayasu Arteritis

• Kim SY
• Park JH
• Chung JW
• Kim HC
• Lee W
• So YH
• Jae HJ

• KMID: 1110725
• DOI: http://doi.org/10.3348/kjr.2007.8.4.286

Abstract

OBJECTIVE
We wanted to evaluate the mural changes by CT on the follow-up examination of patients with active Takayasu arteritis. MATERIALS AND METHODS: The study included 18 patients, (4 males and 14 females), with active Takayasu arteritis. A total of 44 CT examinations were done during the follow-up period (mean: 55.6 months). At the time of the last follow-up CT, the disease, on the basis of the erythrocyte sedimentation rate (ESR), was found to be inactive in five patients and the disease was active and persistent in 13 patients. The thickness and CT attenuation of the aortic wall on the precontrast, arterial and venous phases were measured on the initial and the follow-up CT examinations. The ratio of the mural attenuation over that of the back muscle on the initial CT was compared with the ratio found on the follow-up CT. RESULTS: The initial CT findings included high density and calcifications of the aortic wall in the precontrast images and a thickened wall with enhancements in the arterial and the venous phases. A low-attenuation ring was demonstrated in the venous phase in 15 patients (83%). On the follow-up evaluation, the mean mural thickness decreased significantly from 4.1 mm to 2.4 mm. The mean mural attenuation ratio in the venous phase decreased significantly from 1.9 to 1.3 (p = 0.001). The low attenuation ring was identified in seven patients (39%) who had only with active, persistent Takayasu arteritis. CONCLUSION: The mural changes demonstrated by the follow-up CT evaluations for the patients with active Takayasu arteritis included a decrease of the mural thickness and enhancement, disappearance of the low-attenuation ring on the venous phase, and an increase of the mural attenuation and calcification on the precontrast phase.

Keyword

Takayasu arteritis; Computed tomography (CT)

MeSH Terms

Adolescent
Adult
*Aortography
Blood Sedimentation
Child
Contrast Media/administration & dosage
Female
Follow-Up Studies
Humans
Iohexol/administration & dosage/analogs & derivatives
Male
Middle Aged
Pulmonary Artery/radiography
Retrospective Studies
Takayasu Arteritis/*radiography
Tomography, X-Ray Computed

Figure

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  Fig. 1 A 34-year-old male patient with Takayasu arteritis (Case 7). The initial CT of the arterial phase at the level of the right pulmonary artery (A) reveals a mural thickening of the ascending and the descending aorta. In the venous phase (B), the thickened wall is enhanced with a inner low-attenuation ring. The follow-up CT evaluation made six years, four months after the initial CT reveals a significantly decreased mural thickness on the arterial phase (C). The CT image of the same level on the venous phase (D) shows a decrease of the thickness and enhancement of the aortic wall with disappearance of the inner low-attenuation ring.

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  Fig. 2 An 11-year-old female patient with Takayasu arteritis (Case 1). Abdominal CT of the arterial phase at the level of the renal vein (A) shows a concentric wall thickening of the aorta at the origin of the left renal artery. On the venous phase (B), the wall is enhanced significantly with a low-attenuation ring. After three years, seven months, the follow-up CT on the arterial phase (C) and the venous phase (D) reveals a marked decrease of the mural thickening. The disease was defined as inactive at the time of the follow-up CT, with normal erythrocyte sedimentation rate without steroid treatment. Focal stenosis developed at the proximal left renal artery, which was later successfully treated with percutaneous balloon angioplasty.

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  Fig. 3 A 40-year-old female patient with Takayasu arteritis (Case 9). In comparison with the initial precontrast CT (A), the follow-up CT at five years, two months reveals a progressive calcification of the ascending aorta that was noted (B). Transverse CT of the arch vessels demonstrates significant wall thickening on the arterial phase (C) and enhancement on the venous phase (D) at the time of the initial study. The mural changes were found to persist on the follow-up CT of the arterial phase (E) and the venous phase (F) even after five years two months of steroid treatment.

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