Diagnostic value of Contrast-Enhanced MR-Angiography in diagnosing large Vessel Vasculitis

Sabine Adler¹, Marco Sprecher¹, Harald Bonel², Thorsten Klink² and Peter M. Villiger³, ¹Rheumatology, Immunology, Allergology, University Hospital Bern, Bern, Switzerland, ²Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Bern, Switzerland, ³Rheumatology, Immunology and Allergology, University Hospital Bern, Bern, Switzerland

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Clinical, diagnostic imaging and large vessel vasculitis, MRI

Session Information

Title: Imaging of Rheumatic Diseases: Magnetic Resonance Imaging (MRI)

Session Type: Abstract Submissions (ACR)

Background/Purpose

Diagnosis of large-vessel vasculitis (LVV) remains difficult despite clinical and serological signs and symptoms. Detection by histology might be unavailable in exclusive thoracic or abdominal involvement. PET-scans rarely are ready to be used in every-day practice and CT-scans might miss vascular affections. The value of easily accessible, contrast-enhanced MR-angiographies has only rarely been described.

Methods

Between 2005 and 2012 we investigated 76 patients (44 females, 32 males, aged 18-82 years, mean age 64.5 years) with clinical and serological suspicion of LVV by contrast-enhanced MR-angiography (MRA). Gadolinium was used as contrast-medium. Twenty-nine patients underwent both thoracic and abdominal MRA, 32 patients had thoracic and 15 patients abdominal MRA only. Additional histologies of the temporal arteries were performed in 22 patients. MRAs were independently reviewed by two radiologists. Correlations were measured for clinical, serological, histological and radiological parameters.

Results

LVV was diagnosed by MRA in 20/76 patients with 13/20 being abdominal and 7/20 thoracical vasculitides. Out of those, nine patients showed both thoracical and abominal LVV. Interobserver agreement regarding LVV correlated in all but one patient. Diagnoses other than LVV were fibrosis in 36/76 patients, vascular stenosis in 2/76 and arterial dissection in another 2/76 patients. The remaining 10/76 patients showed no vascular abnormalities. In 7/22 biopsied patients, histology was positive for temporal arteritis; 2 out of those 7 patients had additional LVV. Neither erythrocyte sedimentation rate (ESR) nor C-reactive protein (CRP) showed significant differences regarding patients with or without LVV.

Conclusion

Occult LVV can be detected by MRA despite negative serological and/or histological parameters. MRA enables distinguished diagnosis and therefore initiation of tailored immunosuppression in LVV and allows for follow-up investigations in order to control therapeutic success.

Disclosure:

S. Adler,
None;

M. Sprecher,
None;

H. Bonel,
None;

T. Klink,
None;

P. M. Villiger,
None.

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