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Imaging Findings in Takayasu's Arteritis

¹ Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94143.
² Department of Radiology, San Francisco General Hospital, 1001 Potrero Ave., Rm. 1X 55A, Box 1325, San Francisco, CA 94110.
³ Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.

View larger version (118K): [in a new window]   Fig. 1A. —45-year-old-woman with Takayasu's arteritis and graft placement for abdominal aortic occlusion. Coronal maximum-intensity-projection (MIP) (A) and volume-rendered (B) images show supraceliac aorta-to-right iliac artery bypass graft (single large arrow) and supraceliac aorta-to-right renal artery bypass graft (double small arrows) with occlusion (single small arrow) of midportion abdominal aorta below superior mesenteric artery origin, best shown on MIP image (A). Left renal artery is supplied via bypass graft (single arrowhead). Superior mesenteric artery is supplied from left iliac artery bypass graft (double arrowheads).

View larger version (57K): [in a new window]   Fig. 1B. —45-year-old-woman with Takayasu's arteritis and graft placement for abdominal aortic occlusion. Coronal maximum-intensity-projection (MIP) (A) and volume-rendered (B) images show supraceliac aorta-to-right iliac artery bypass graft (single large arrow) and supraceliac aorta-to-right renal artery bypass graft (double small arrows) with occlusion (single small arrow) of midportion abdominal aorta below superior mesenteric artery origin, best shown on MIP image (A). Left renal artery is supplied via bypass graft (single arrowhead). Superior mesenteric artery is supplied from left iliac artery bypass graft (double arrowheads).

View larger version (137K): [in a new window]   Fig. 2. —50-year-old woman with Takayasu's arteritis (TA). Catheter angiography shows mild infrarenal abdominal aortic stenosis (arrow). Although atherosclerosis commonly affects infrarenal abdominal aorta, atherosclerosis usually produces abrupt caliber changes just beyond stenosis sites; the smooth tapered nature of this stenosis favors TA.

View larger version (112K): [in a new window]   Fig. 3. —45-year-old woman with Takayasu's arteritis. Catheter angiography shows severe infrarenal abdominal aortic stenosis (arrows).

View larger version (139K): [in a new window]   Fig. 4. —45-year-old woman with Takayasu's arteritis. Oblique projection catheter angiogram shows segmental stenosis of origin of right upper lobe pulmonary artery (single arrow). Other stenoses are also visible (double arrows).

View larger version (95K): [in a new window]   Fig. 5. —52-year-old woman with Takayasu's arteritis. Catheter angiogram shows severe infrarenal abdominal aortic stenosis, ending in aortic occlusion (arrow), with extensive collateral vessel formation.

View larger version (146K): [in a new window]   Fig. 6. —38-year-old woman with Takayasu's arteritis. Catheter angiogram shows severe infrarenal abdominal aortic stenosis (arrowhead) with extensive collateral vessel formation by enlarged pancreaticoduodenal artery between superior mesenteric and celiac arteries (arrows).

View larger version (147K): [in a new window]   Fig. 7A. —40-year-old woman with aneurysmal form of Takayasu's arteritis. Thoracic CT angiogram shows aneurysm of left subclavian artery (arrow) at origin of left vertebral artery.

View larger version (137K): [in a new window]   Fig. 7B. —40-year-old woman with aneurysmal form of Takayasu's arteritis. Thoracic CT angiogram obtained caudal to A shows large aneurysm (arrow) of brachiocephalic artery and proximal right subclavian artery.

View larger version (154K): [in a new window]   Fig. 7C. —40-year-old woman with aneurysmal form of Takayasu's arteritis. Volume-rendered image shows right subclavian artery aneurysm (arrowheads) to advantage.

View larger version (91K): [in a new window]   Fig. 8. —45-year-old woman with aneurysmal form of Takayasu's arteritis. Axial CT image shows aneurysm of proximal descending thoracic aorta (arrow). Differential diagnosis should include atherosclerosis, mycotic aneurysm, and Behçet's syndrome.

View larger version (187K): [in a new window]   Fig. 9A. —40-year-old woman with aneurysmal form of Takayasu's arteritis. Thoracic CT angiogram obtained through heart shows aneurysm (arrow) of left anterior descending coronary artery.

View larger version (190K): [in a new window]   Fig. 9B. —40-year-old woman with aneurysmal form of Takayasu's arteritis. Thoracic CT angiogram obtained caudal to A shows aneurysm (arrow) of left circumflex coronary artery.

View larger version (135K): [in a new window]   Fig. 10. —50-year-old woman with Takayasu's arteritis in late stage of disease. Unenhanced CT scan shows extensive calcification (arrow) composing abdominal aortic lumen.

View larger version (86K): [in a new window]   Fig. 11A. —19-year-old man with early Takayasu's arteritis. Axial T1-weighted MR image (TR/TE, 500/20) obtained through superior mediastinum shows thickening of right brachiocephalic artery wall (arrowheads).

View larger version (108K): [in a new window]   Fig. 11B. —19-year-old man with early Takayasu's arteritis. Axial T1-weighted gadolinium-enhanced MR image (500/20) shows extensive enhancement of abnormally thickened right brachiocephalic artery wall (arrowheads).

View larger version (97K): [in a new window]   Fig. 12A. —32-year-old woman with Takayasu's arteritis. Axial T1-weighted MR image (TR/TE, 500/20) shows concentric thickening of infrarenal abdominal aorta (arrow).

View larger version (115K): [in a new window]   Fig. 12B. —32-year-old woman with Takayasu's arteritis. Axial T1-weighted MR image (500/20) with fat saturation after gadolinium administration shows extensive enhancement of thickened abdominal aorta (arrow).

View larger version (84K): [in a new window]   Fig. 13. —50-year-old woman with Takayasu's arteritis. Coronal MR angiogram shows short-segment occlusion of infrarenal abdominal aorta (long arrow). Occlusion of right common femoral artery (short arrows) is also evident.

View larger version (128K): [in a new window]   Fig. 14. —59-year-old woman with multifocal great vessel stenoses due to Takayasu's arteritis (TA). Maximum-intensity-projection coronal MR angiogram shows occlusion of right brachiocephalic artery (arrow), severe stenosis of right subclavian artery (single arrowhead), and occlusion of proximal left subclavian artery (double arrowheads). Subclavian arteries are reconstituted by collateral vessel formation bilaterally. Note relatively proximal great vessel involvement; whereas giant cell arteritis may have imaging appearance similar to that of TA, lesions are usually located more distally in latter disorder.

View larger version (104K): [in a new window]   Fig. 15. —55-year-old woman with Takayasu's arteritis, infrarenal abdominal aortic occlusion, and surgical arterial bypass graft. Coronal maximum-intensity-projection MR angiogram shows occluded infrarenal abdominal native aorta (arrow) and surgical bypass graft (arrowheads) with reimplanted abdominal vasculature.

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