Takayasu's Arteritis
Assessment of Disease Activity with Contrast-Enhanced MR Imaging
Yeon Hyeon Choe1,
Boo-Kyung Han1,
Eun-Mi Koh2,
Duk-Kyung Kim3,
Young Soo Do1 and
Won Ro Lee3
1
Department of Radiology, Samsung Medical Center, Sungkyunkwan University
School of Medicine, 50, Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea.
2
Department of Internal Medicine, Division of Rheumatology, Sungkyunkwan
University School of Medicine, Seoul 135-710, Korea.
3
Department of Internal Medicine, Divsion of Cardiology, Sungkyunkwan
University School of Medicine, Seoul 135-710, Korea.
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Fig. 1A. —Drawings show classification of patterns of aortic wall changes in
Takayasu's arteritis on high-resolution contrast-enhanced T1-weighted
spin-echo MR images. Innermost zone is revealed as brighter than middle gray
zone. Outer zone is brightest of three layers and indistinguishable from
surrounding fat. In type A, middle layer is thickest of three layers of
thickened aortic wall. i = intimal layer; m = media; a = adventitia,
periadventitial fat, or both.
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Fig. 1B. —Drawings show classification of patterns of aortic wall changes in
Takayasu's arteritis on high-resolution contrast-enhanced T1-weighted
spin-echo MR images. Innermost zone is revealed as brighter than middle gray
zone. Outer zone is brightest of three layers and indistinguishable from
surrounding fat. In type B, innermost layer is thicker than or equal to middle
layer.
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Fig. 1C. —Drawings show classification of patterns of aortic wall changes in
Takayasu's arteritis on high-resolution contrast-enhanced T1-weighted
spin-echo MR images. Innermost zone is revealed as brighter than middle gray
zone. Outer zone is brightest of three layers and indistinguishable from
surrounding fat. In type C, innermost and middle layers are not separable
because they have equal signal intensity. a = adventitia, periadventitial fat,
or both.
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Fig. 1D. —Drawings show classification of patterns of aortic wall changes in
Takayasu's arteritis on high-resolution contrast-enhanced T1-weighted
spin-echo MR images. Innermost zone is revealed as brighter than middle gray
zone. Outer zone is brightest of three layers and indistinguishable from
surrounding fat. In type D, small areas of signal void in middle or outer
layers represent dilated neovessels. v = new vessels in inflamed aortic
wall.
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Fig. 1E. —Drawings show classification of patterns of aortic wall changes in
Takayasu's arteritis on high-resolution contrast-enhanced T1-weighted
spin-echo MR images. Innermost zone is revealed as brighter than middle gray
zone. Outer zone is brightest of three layers and indistinguishable from
surrounding fat. In type E, periadventitial fat layer is also involved, as
indicated by inflammation.
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Fig. 1F. —Drawings show classification of patterns of aortic wall changes in
Takayasu's arteritis on high-resolution contrast-enhanced T1-weighted
spin-echo MR images. Innermost zone is revealed as brighter than middle gray
zone. Outer zone is brightest of three layers and indistinguishable from
surrounding fat. In type F, focal thinning of aortic wall or pseudoaneurysm is
found in aneurysmal segment. a = adventitia, periadventitial fat, or both.
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Fig. 2. —28-year-old healthy female volunteer. High-resolution
contrast-enhanced spin-echo MR image (field of view, 14 x 14 cm; slice
thickness, 4 mm; matrix size, 256 x 160; two averaging) with fat
saturation using a body coil shows normal aorta. Aortic wall is not
significantly enhanced compared with myocardium.
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Fig. 3A. —Wall-change patterns revealed on contrast-enhanced T1-weighted
spin-echo MR images in patients with active Takayasu's arteritis. Type A
lesion is revealed at ascending aorta (arrow) of 20-year-old
woman.
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Fig. 3B. —Wall-change patterns revealed on contrast-enhanced T1-weighted
spin-echo MR images in patients with active Takayasu's arteritis. Type B
lesion (arrow) is revealed in abdominal aorta of 34-year-old
woman.
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Fig. 3C. —Wall-change patterns revealed on contrast-enhanced T1-weighted
spin-echo MR images in patients with active Takayasu's arteritis. Type C
lesions with homogeneously bright walls of ascending and descending thoracic
aorta are revealed on this fat-saturated image of 15-year-old girl. Also, note
dilated vessels (arrowheads) in thickened aortic wall and thick walls
(arrows) of main and right lower lobe branch pulmonary arteries.
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Fig. 3D. —Wall-change patterns revealed on contrast-enhanced T1-weighted
spin-echo MR images in patients with active Takayasu's arteritis. Type D
lesion with dilated neovessels (arrows) is revealed in thick aortic
wall of 25-year-old woman.
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Fig. 3E. —Wall-change patterns revealed on contrast-enhanced T1-weighted
spin-echo MR images in patients with active Takayasu's arteritis. Type F
lesion with aneurysm (arrow) is seen at ascending aorta of
15-year-old girl (same patient as in C).
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Fig. 4A. —4-year-old girl with active Takayasu's arteritis. Unenhanced
T1-weighted MR image shows marked thickening of descending thoracic aorta
(arrow).
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Fig. 4B. —4-year-old girl with active Takayasu's arteritis. Early
contrast-enhanced T1-weighted MR image shows marked enhancement of aortic wall
and periaortic tissue (arrow, type E lesion), which exceeds degree of
myocardial enhancement.
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Fig. 4C. —4-year-old girl with active Takayasu's arteritis. T2-weighted
spin-echo MR image (TR/TE, 1585/80) shows bright signal in and around stenotic
descending thoracic aorta (arrow), which may indicate edema in
inflamed aortic wall.
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Fig. 5A. —42-year-old woman with inactive Takayasu's arteritis.
Contrast-enhanced MR image obtained after 5 months of medical treatment shows
persistently thick wall of aortic arch and dilated ascending aorta. Patient's
erythrocyte sedimentation rate had decreased from 60 mm/hr before treatment to
20 mm/hr. Degree of aortic wall enhancement is minimal and less than that of
myocardial enhancement (not shown).
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Fig. 5B. —42-year-old woman with inactive Takayasu's arteritis. T2-weighted MR
image obtained at same level as A shows no evidence of mural edema.
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Fig. 6. —Graph shows relationship of aortic signal intensity relative to
myocardial signal intensity and erythrocyte sedimentation rate in 26 patients
(r = 0.78, p < 0.005) on contrast-enhanced MR
imaging.
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Fig. 7. —Graph shows relationship of aortic signal intensity relative to
myocardial signal intensity and C-reactive protein level in 26 patients
(r = 0.63, p < 0.005) on contrast-enhanced MR
imaging.
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Fig. 8A. —25-year-old woman with active Takayasu's arteritis. T1-weighted
contrast-enhanced MR image shows wall of right common carotid artery
(arrow) to be thick and markedly enhanced.
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Fig. 8B. —25-year-old woman with active Takayasu's arteritis. Follow-up
T1-weighted contrast-enhanced MR image obtained 2 months after A
reveals diminished wall thickness and lesser degree of enhancement.
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Copyright © 2000 by the American Roentgen Ray Society.
