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MRI of Takayasu's Arteritis: Typical Appearances and Complications

Eijun Sueyoshi1, Ichiro Sakamoto1 and Masataka Uetani1

1 All authors: Department of Radiology, Nagasaki University School of Medicine, Sakamoto 1-7-1, Nagasaki 852-8501, Japan.


Figure 1
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  		Fig. 1A —23-year-old man with Takayasu's arteritis in acute phase. Axial T1-weighted image (TR/TE, 857/20) shows wall thickening of ascending aorta and pulmonary artery.

 

Figure 2
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  		Fig. 1B —23-year-old man with Takayasu's arteritis in acute phase. Axial T1-weighted image (TR/TE, 800/14) shows improvement of wall thickening of ascending aorta and pulmonary artery after steroid therapy.

 

Figure 3
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  		Fig. 2A —24-year-old woman with Takayasu's arteritis in acute phase. Axial T1-weighted image (TR/TE, 600/14) shows wall thickening of aortic branches.

 

Figure 4
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  		Fig. 2B —24-year-old woman with Takayasu's arteritis in acute phase. Fat-suppressed contrast-enhanced T1-weighted image (TR/TE, 550/14) shows thickening and enhancement of wall of aortic branches. Fat-suppressed contrast-enhanced T1-weighted image can well depict enhancement of arterial wall because of active inflammation.

 

Figure 5
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  		Fig. 3A —30-year-old woman with Takayasu's arteritis in acute phase. Contrast-enhanced 3D MR angiography (TR/TE, 6.1/1.4; flip angle, 20°) shows complete occlusion of right pulmonary, left common carotid, and left subclavian arteries. Sometimes occlusion of pulmonary artery and aortic branches is seen in acute phase.

 

Figure 6
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  		Fig. 3B —30-year-old woman with Takayasu's arteritis in acute phase. Early source image of 3D MR angiography shows wall thickening of aortic arch (arrow).

 

Figure 7
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  		Fig. 3C —30-year-old woman with Takayasu's arteritis in acute phase. Late source image shows enhancement of aortic wall (arrow).

 

Figure 8
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  		Fig. 4 —30-year-old woman with Takayasu's arteritis in acute phase. Axial T1-weighted images (TR/TE, 923/20) show pseudoaneurysm arising from aortic arch. Mild wall thickening of descending aorta is also seen. In Takayasu's arteritis, pseudoaneurysm formation is sometimes seen in acute phase.

 

Figure 9
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  		Fig. 5A —53-year-old woman with Takayasu's arteritis in late phase. Contrast-enhanced 3D MR angiography (TR/TE, 5.9/1.2; flip angle, 20°) shows dilatation of ascending aorta. Diffuse narrowing of descending thoracic aorta is also seen.

 

Figure 10
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  		Fig. 5B —53-year-old woman with Takayasu's arteritis in late phase. Contrast-enhanced 3D MR angiography (TR/TE, 5.9/1.2; flip angle, 20°) shows diffuse narrowing of abdominal aorta. These findings are typical features of aorta in late phase of Takayasu's arteritis.

 

Figure 11
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  		Fig. 6A —27-year-old woman with Takayasu's arteritis in late phase. Oblique sagittal T1-weighted image (TR/TE, 923/20) shows dilatation of ascending aorta.

 

Figure 12
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  		Fig. 6B —27-year-old woman with Takayasu's arteritis in late phase. Cine MR image (TR/TE, 5.2/1.8; flip angle, 30°) shows broad signal void (arrow) from aortic valve to left ventricle, suggesting aortic regurgitation.

 

Figure 13
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  		Fig. 7 —29-year-old woman with Takayasu's arteritis and renal hypertension in late phase. Contrast-enhanced 3D MR angiography (TR/TE, 5.9/1.2; flip angle, 20°) shows severe stenosis of right renal artery, which is nearly occluded (arrow).

 

Figure 14
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  		Fig. 8 —59-year-old woman with Takayasu's arteritis in late phase. Contrast-enhanced 3D MR angiography (TR/TE, 8.6/1.8; flip angle, 20°) shows occlusion of proximal portion of left subclavian artery (arrow). Left subclavian artery is opacified via left vertebral artery (subclavian steal syndrome, arrowheads).

 

Figure 15
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  		Fig. 9A —41-year-old woman with Takayasu's arteritis in late phase. Contrast-enhanced 3D MR angiography (TR/TE, 7.1/1.4; flip angle, 20°) shows occlusion of left subclavian artery. Irregularities of vessel lumen of other aortic branches are also shown.

 

Figure 16
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  		Fig. 9B —41-year-old woman with Takayasu's arteritis in late phase. FLAIR images of brain (TR/TE, 8002/114; TI, 2000) show brain atrophy caused by chronic ischemia because of occlusion and stenoses of aortic branches. High signal spots are seen in deep white matter, suggesting small infarctions.

 

Figure 17
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  		Fig. 9C —41-year-old woman with Takayasu's arteritis in late phase. FLAIR images of brain (TR/TE, 8002/114; TI, 2000) show brain atrophy caused by chronic ischemia because of occlusion and stenoses of aortic branches. High signal spots are seen in deep white matter, suggesting small infarctions.

 

Figure 18
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  		Fig. 10 —52-year-old man with Takayasu's arteritis in late phase. Contrast-enhanced 3D MR angiography (TR/TE, 6.1/1.3; flip angle, 20°) shows segmental septa of the right innominate artery (arrow). This finding is characteristic of Takayasu's arteritis.

 

Figure 19
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  		Fig. 11A —23-year-old woman with Takayasu's arteritis in late phase. 2D contrast-enhanced MR perfusion images (TR/TE, 5.3/1.3; flip angle, 30°) shows obstructive lesion in left middle lung field (arrow).

 

Figure 20
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  		Fig. 11B —23-year-old woman with Takayasu's arteritis in late phase. Pulmonary perfusion scintigrams in anterior projections show perfusion defects in left middle lung field (arrow). This finding correlates with MR perfusion image.

 

Figure 21
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  		Fig. 12A —50-year-old woman with Takayasu's arteritis in late phase. Axial T1-weighted image (TR/TE, 576/14) shows aortic dissection in descending aorta. False lumen with mural thrombus (F) is markedly dilated. True lumen is compressed by false lumen (arrow).

 

Figure 22
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  		Fig. 12B —50-year-old woman with Takayasu's arteritis in late phase. Multiplanar reconstruction (MPR) image obtained from source images of contrast-enhanced 3D MR angiography (TR/TE, 6.1/1.3; flip angle, 20°) shows an entry site (arrow).

 

Figure 23
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  		Fig. 13A —55-year-old woman with Takayasu's arteritis in late phase. This patient underwent bypass graft for occlusion of left carotid and subclavian arteries. Contrast-enhanced 3D MR angiography (TR/TE, 6.0/1.2; flip angle, 20°) shows patency of bypass graft, connecting left femoral, left carotid, and left subclavian arteries.

 

Figure 24
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  		Fig. 13B —55-year-old woman with Takayasu's arteritis in late phase. This patient underwent bypass graft for occlusion of left carotid and subclavian arteries. Contrast-enhanced 3D MR angiography (TR/TE, 6.0/1.2; flip angle, 20°) shows patency of bypass graft, connecting left femoral, left carotid, and left subclavian arteries.

 

Figure 25
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  		Fig. 13C —55-year-old woman with Takayasu's arteritis in late phase. This patient underwent bypass graft for occlusion of left carotid and subclavian arteries. Contrast-enhanced 3D MR angiography (TR/TE, 6.0/1.2; flip angle, 20°) shows patency of bypass graft, connecting left femoral, left carotid, and left subclavian arteries.

 

Figure 26
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  		Fig. 13D —55-year-old woman with Takayasu's arteritis in late phase. Three years later, axial T1-weighted image (TR/TE, 600/14) shows pseudoaneurysm at anastomosis site of left subclavian artery caused by weakness of arterial wall (arrow).

 

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