AJR:184, May 2005 1427 AJR 2005;184:1427–1431 0361–803X/05/1845–1427 © American Roentgen Ray Society MR Imaging Desai et al. MRI of Takayasu’s Arteritis Original Report Milind Y. Desai 1 John H. Stone 2 Thomas K. F. Foo 3 David B. Hellmann João A. C. Lima David A. Bluemke 4 Desai MY, Stone JH, Foo T, Hellmann D, Lima JAC, Bluemki DA Received May 25, 2004; accepted after revision July 30, 2004. 1 Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD. 2 Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD. 3 Applied Science Laboratory, GE Healthcare, Milwaukee, WI. 4 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N Wolfe St., Baltimore, MD 21287. Address correspondence to D. A. Bluemke (dbluemke@jhmi.edu). Delayed Contrast-Enhanced MRI of the Aortic Wall in Takayasu’s Arteritis: Initial Experience OBJECTIVE. Delayed contrast-enhanced MRI is increasingly being used for cardiac viability imaging. Takayasu’s arteritis is a rare inflammatory disorder of unknown cause that affects the aorta, its major branches, and the pulmonary artery; it is characterized by inflammation and fibrosis in the arterial wall. We report our initial experience with seven patients (six women, one man; age range, 25–62 years) with delayed (20 min) gadolinium-enhanced MRI (inversion recovery prepared gated fast gradient-echo pulse sequence) in patients with known Takayasu’s arteritis. CONCLUSION. Patients with Takayasu’s arteritis (particularly those with abnormal lab- oratory values) have evidence of delayed hyperenhancement on delayed contrast-enhanced MRI. Thus, delayed contrast-enhanced MRI might be a useful technique to identify inflamma- tion in arterial wall. akayasu’s arteritis is a rare inflam- matory disorder of unknown cause that affects the aorta, its major branches, and the pulmonary artery [1–3]. Invasive or noninvasive angiography shows stenosis and dilation of the aorta, its branches, or both [4]. Thickening of the aortic wall detectable on cross-sectional imaging can precede angiographic changes [5, 6]. The main- stay of treatment is long-term corticosteroid therapy, but its attendant side effects are signif- icant. Disease activity is usually inferred from patient symptoms, aggravation of angiographic lesions, or increased laboratory values of in- flammatory markers such as erythrocyte sedi- mentation rate (ESR) [7, 8]. However, ESR values have been reported to be normal in up to one third of the patients with active disease de- termined by other parameters, and 56% of pa- tients with disease in remission have a persistently elevated ESR level [7]. Signal intensity change of the arterial wall on gadolinium-enhanced spin-echo MRI is a po- tential new method to define active Takayasu’s arteritis that may offer improved specificity compared with serum laboratory measures [9]. In this method, chemical shift fat suppression is used to decrease background signal intensity and thus increase visualization of signal inten- sity changes in the arterial wall. In our experi- ence, these signal changes can be subtle and may be obscured by inhomogeneous fat sup- pression related to susceptibility changes result- ing from air–soft-tissue interfaces in the chest or neck. The purpose of this article is to describe a new MR method to show arterial wall enhance- ment based on delayed gadolinium enhance- ment combined with an inversion recovery prepared gradient-echo pulse sequence. Materials and Methods Patients The study population consisted of seven patients (six women, one man; age range, 25–62 years) with a known diagnosis of Takayasu’s arteritis who were referred to our MR laboratory for routine fol- low-up or to monitor progression of the disease. The diagnosis of Takayasu’s arteritis was made on the basis of previously described criteria [10]. The duration of the disease ranged from 1 to 16 years. All patients had laboratory tests, including com- plete blood count, ESR, and C-reactive protein lev- T Downloaded from www.ajronline.org by 52.73.204.196 on 05/17/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved