Background Large vessel vasculitis affecting the aorta and its primary branches may present with symptoms and findings that closely mimic other diseases, making the diagnosis difficult. Conventional inflammatory markers may not provide therapeutic direction as data suggests that up to 50% of ESR/CRP measurements can be false positive in regards to disease activity. Because of the central location of the arteries involved, biopsy is generally not an option. Imaging of large vessel vasculitis is the current gold standard to confirm a diagnosis and to follow disease course. Conventional arterial imaging lacks specificity because different pathologies produce similar luminal defects and findings are not always associated with disease activity.
The technique double inversion “black blood” MRI has shown value in assessment of the morphologic features of the great vessels. This technique suppresses the signal from the blood in the vessel enabling the delineation of the arterial wall from the lumen and the surrounding perivascular tissue. Furthermore, post-contrast T1 weighted sequences allow visualization of contrast enhancement of the arterial wall. Vessel wall enhancement on MRI in the setting of large vessel vasculitis has previously been assessed, but only few reports have use double inversion dark lumen techniques.
Objectives The purpose of this study is to review the utility of a new imaging modality termed double inversion “black blood” MRI/A in the diagnosis and management of large vessel vasculitis.
Methods We reviewed our records over the past year to identify patients with possible active large vessel vasculitis with normal values of acute phase reactants or with an inconclusive diagnosis. Data extracted included age, gender, acute phase reactants, symptoms at presentation and results of black-blood MRI/A.
Results See Table 1
Outcomes Imaging confirmed a new diagnosis of vasculitis in 2 patients with normal acute phase reactants.
Imaging rule out acive disease in 2 patients with history of vasculitis.
Imaging identified active disease and treatment failure in 2 patients requiring a change of therapy.
Conclusions Double inversion black blood MRI/A can be sensitive and specific in the diagnosis and evaluation of disease activity in large vessel vasculitis, specifically in patients with nonspecific symptoms and normal acute phase reactants.
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Yeon Hyeon, Boo Kyung, et al. Takayasu's Arteritis: Assesment of Disease Activity with MRI/MRA. AJR:175, 2000.
Disclosure of Interest None declared