Download PDF
Ultraschall Med 2019; 40(05): 638-645
DOI: 10.1055/a-0817-5423
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Assessment of Disease Activity in Takayasu Arteritis: Potential Role of Contrast-Enhanced Ultrasound

Beurteilung der entzündlichen Aktivität der Takayasu-Arteriitis: Potenzial der Kontrastmittelsonografie
Christian Lottspeich
1   Sonography Unit, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
,
Claudia Dechant
2   Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
,
Anton Köhler
3   Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwigs-Maximilians-University, Munich, Germany
,
Maximilian Tischler
3   Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwigs-Maximilians-University, Munich, Germany
,
Karla Maria Treitl
4   Clinic and Policlinic for Radiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
,
Marcus Treitl
4   Clinic and Policlinic for Radiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
,
Hendrik Schulze-Koops
2   Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
,
Ulrich Hoffmann
3   Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwigs-Maximilians-University, Munich, Germany
,
Michael Czihal
3   Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwigs-Maximilians-University, Munich, Germany
› Author Affiliations
Further Information

Publication History

21 September 2018

28 November 2018

Publication Date:
23 January 2019 (online)

Also available at
    Permissions and Reprints

Abstract

Purpose To assess the diagnostic value of intima media thickness measurements and contrast-enhanced ultrasound (CEUS) of the supraaortic arteries in the assessment of disease activity in Takayasu arteritis (TA).

Materials and Methods Patients with TA and involvement of the carotid and/or subclavian/axillary arteries underwent CEUS imaging in addition to B-mode and color duplex ultrasound. The maximum IMT (mIMT) was measured and high-resolution CEUS of the most prominently thickened vessel segment was performed. Two blinded readers reviewed the CEUS movies, with semiquantitative assessment of microbubble enhancement of the arterial wall (grade 0: no or minimal; grade 1: moderate; grade 2: pronounced). Clinical symptoms, acute phase reactants, and established indices of clinical disease activity (NIH criteria, ITAS score) were recorded.

Results 40 examinations in 17 patients were analyzed. According to clinical judgement, 27 and 13 cases were classified as clinically inactive and active, respectively. An mIMT-cutoff of > 2.7 mm identified active disease with a sensitivity and specificity of 69.2 % and 88.9 %, respectively (area under the curve 0.83). The interobserver agreement of CEUS analysis was substantial (Cohen’s kappa 0.76). By consensus reading, 17, 15, and 8 cases were classified as uptake grade 0, grade 1 and grade 2, respectively. Grade 0 uptake was exclusively present in 17 clinically inactive patients. Grade 1 uptake was seen in 10 patients with clinically inactive disease and 5 patients with clinically active disease. Grade 2 uptake was exclusively present in 8 patients with active disease.

Conclusion Both sonographic IMT measurements and high-resolution CEUS are promising in the ad-hoc assessment of disease activity in patients with TA.

Zusammenfassung

Ziel Studienziel war die Untersuchung der diagnostischen Wertigkeit der sonografischen Intima-Media-Dicken-Messung und der Kontrastmittelsonografie in der Aktivitätsbeurteilung der Takayasu-Arteriitis (TA).

Material und Methoden Konsekutive Patienten mit Diagnose einer TA und Beteiligung der supraaortalen Arterien wurden einer hochauflösenden Kontrastmittel-Ultraschalluntersuchung (CEUS) zusätzlich zur B-Bild- und Duplexsonografie unterzogen. Die maximale Intima-Media-Dicke der A. carotis communis und A. subclavia/axillaris beidseits wurde bestimmt. Die CEUS-Untersuchung wurde am Gefäßsegment mit der höchsten IMT durchgeführt. 2 verblindete Untersucher bewerteten die CEUS-Filme im Hinblick auf die Anreicherung von Mikrobläschen in der Gefäßwand (Grad 0: keine oder nur minimale Anreicherung; Grad 1: moderate Anreicherung; Grad 2: starke Anreicherung). Klinische Symptome, Entzündungsmarker und etablierte Scores der klinischen Krankheitsaktivität wurden erfasst.

Ergebnisse 40 Untersuchungen von 17 Patientinnen wurden analysiert. Nach klinischer Einschätzung waren 27 Fälle inaktiv, 13 Fälle hingegen aktiv. Ein Grenzwert der maximalen Intima-Media-Dicke von 2,7 mm wies eine Sensitivität und Spezifität von 69,2 % und 88,9 % für die korrekte Diskrimination von aktiver und inaktiver TA auf. Die Übereinstimmung der Untersucher in der Beurteilung der CEUS-Filme war substanziell (Cohens-Kappa 0,76). Gemäß Untersucherkonsens wurden 17, 15 und 8 Fälle mit einer Anreicherung Grad 0, 1, bzw. 2 klassifiziert. Eine Grad-0-Anreicherung fand sich nur bei klinisch inaktiven Patienten, wohingegen eine Grad-1-Anreicherung sowohl bei 10 klinisch inaktiven wie auch 5 klinisch aktiven Patienten vorlag. Eine Grad-2-Anreicherung war ausschließlich bei 8 klinisch aktiven Patienten zu beobachten.

Schlussfolgerung Sowohl die Bestimmung der Intima-Media-Dicke als auch die hochauflösende Kontrastmittelsonografie stellen vielversprechende Verfahren in der Aktivitätsbestimmung der TA dar.

Key words

Takayasu arteritis - large vessel vasculitis - intima media thickness - disease activity - contrast-enhanced ultrasound
 

  • References

  • 1 Dejaco C, Ramiro S, Duftner C. et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018; 77: 636-643
    CrossrefPubMedGoogle Scholar
  • 2 Keser G, Aksu K, Direskeneli H. Discrepancies between vascular and systemic inflammation in large vessel vasculitis: an important problem revisited. Rheumatology (Oxford) 2018; 57: 784-790
    CrossrefPubMedGoogle Scholar
  • 3 Kermani TA, Dasgupta B. Current and emerging therapies in large-vessel vasculitis. Rheumatology (Oxford) 2017 Oct 24 [epub ahead of print]
    PubMedGoogle Scholar
  • 4 Grayson PC, Alehashemi S, Bagheri AA. et al. 18 F-Fluorodeoxyglucose-Positron Emission Tomography As an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients With Large Vessel Vasculitis. Arthritis Rheumatol 2018; 70: 439-449
    CrossrefPubMedGoogle Scholar
  • 5 Quinn KA, Ahlman MA, Malayeri AA. et al. Comparison of magnetic resonance angiography and 18F-fluorodeoxyglucose positron emission tomography in large-vessel vasculitis. Ann Rheum Dis 2018; 77: 1165-1171
    CrossrefPubMedGoogle Scholar
  • 6 Czihal M, Lottspeich C, Hoffmann U. Ultrasound imaging in the diagnosis of large vessel vasculitis. Vasa 2017; 46: 241-253
    CrossrefPubMedGoogle Scholar
  • 7 Giordana P, Baqué-Juston MC, Jeandel PY. et al. Contrast-enhanced ultrasound of carotid artery wall in Takayasu disease:first evidence of application in diagnosis and monitoring of response to treatment. Circulation 2011; 124: 245-247
    CrossrefPubMedGoogle Scholar
  • 8 Schinkel AF, van den Oord SC, van der Steen AF. et al. Utility of contrast-enhanced ultrasound for the assessment of the carotid artery wall in patients with Takayasu or giant cell arteritis. Eur Heart J Cardiovasc Imaging 2014; 15: 541-546
    CrossrefPubMedGoogle Scholar
  • 9 Germanò G, Macchioni P, Possemato N. et al. Contrast-Enhanced Ultrasound of the Carotid Artery in Patients With Large Vessel Vasculitis: Correlation With Positron Emission Tomography Findings. Arthritis Care Res (Hoboken) 2017; 69: 143-149
    PubMedGoogle Scholar
  • 10 Sidhu PS, Cantisani V, Dietrich CF. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall in Med 2018; 39: e2-e44
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Staub D, Schinkel AF, Coll B. et al. Contrast-enhanced ultrasound imaging of the vasa vasorum: from early atherosclerosis to the identification of unstable plaques. JACC Cardiovasc Imaging 2010; 3: 761-771
    CrossrefPubMedGoogle Scholar
  • 12 Kerr GS, Hallahan CW, Giordano J. et al. Takayasu arteritis. Ann Intern Med 1994; 120: 919-929
    PubMedGoogle Scholar
  • 13 Misra R, Danda D, Rajappa SM. Indian Rheumatology Vasculitis (IRAVAS) group. et al. Development and initial validation of the Indian Takayasu Clinical Activity Score (ITAS2010). Rheumatology (Oxford) 2013; 52: 1795-1801
    CrossrefPubMedGoogle Scholar
  • 14 Seth S, Goyal NK, Jagia P. et al. Carotid intima-medial thickness as a marker of disease activity in Takayasu’s arteritis. Int J Cardiol 2006; 108: 385-390
    CrossrefPubMedGoogle Scholar
  • 15 Weyand CM, Goronzy JJ. Immune mechanisms in medium and large-vessel vasculitis. Nat Rev Rheumatol 2013; 9: 731-740
    CrossrefPubMedGoogle Scholar
  • 16 Czihal M, Lottspeich C, Schröttle A. et al. Relapses in three patients with Takayasu arteritis under tocilizumab treatment detected by contrast enhanced ultrasound. Vasa 2018; 47: 149-152
    CrossrefPubMedGoogle Scholar
  • 17 Dikkes A, Aschwanden M, Imfeld S. et al. Takayasu arteritis: active or not, that’s the question. Rheumatology (Oxford) 2017; 56: 1818-1819
    CrossrefPubMedGoogle Scholar