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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2021  |  Volume : 32  |  Issue : 1  |  Page : 265-267
The Magnetic Resonance Imaging in the Takayasu's Arteritis


1 Department of Nephrology, Dialysis and Renal Transplant, ARNAS Civico and Di Cristina Hospital, Palermo, Italy
2 Department of Radiology, Dialysis and Renal Transplant, ARNAS Civico and Di Cristina Hospital, Palermo, Italy

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Date of Web Publication16-Jun-2021
 

How to cite this article:
Cavoli GL, Bono L, Finazzo F, Vallone MG, Tortorici C, Azzolina V, Utri RD, Li Cavoli TV, Mongiovì R, Amato A, Servillo F, Giammarresi C, Carollo C, Zagarrigo C, Oliva B, Schillaci O, Tralongo A. The Magnetic Resonance Imaging in the Takayasu's Arteritis. Saudi J Kidney Dis Transpl 2021;32:265-7

How to cite this URL:
Cavoli GL, Bono L, Finazzo F, Vallone MG, Tortorici C, Azzolina V, Utri RD, Li Cavoli TV, Mongiovì R, Amato A, Servillo F, Giammarresi C, Carollo C, Zagarrigo C, Oliva B, Schillaci O, Tralongo A. The Magnetic Resonance Imaging in the Takayasu's Arteritis. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2021 Dec 5];32:265-7. Available from: https://www.sjkdt.org/text.asp?2021/32/1/265/318537


To the Editor,

In large vasculitis vessels (LVV), i.e. Takayasu’ Arteritis (TA), idiopathic arteritis and giant cell arteritis (GCA), the arterial stenosis are detected by conventional angiography but the potential risk of complication (arterial dissection, iatrogenic embolization, hematoma, allergic reactions) suggests the use of different imaging modalities. The biopsy of the temporal artery biopsy is considered the standard test to confirm the diagnosis of GCA but it is invasive and lacks sensitivity. Usually, the first detectable abnormality is the thickening of arterial wall. In TA, both studies on magnetic resonance imaging (MRI) and computed tomography (CT) revealed excellent specificities and sensitivities compared to conventional angiography. Up to date for the diagnosis of LVV the conventional angiography is not recommended because it has been superseded by the newer imaging modalities. In the experience of Yamada in 20 patients with TA, magnetic resonance angiography (MRA) could find stenosis, dilatation and other aortic lesions; these MRA findings were confirmed by conventional CT-angiography. For diagnosis of TA the specificity, sensitivity and accuracy of MRA in the aorta and its major branches were estimated to be 100%. In this study for the detection of vascular lesions in TA, MRA had a high diagnostic accuracy, using conventional angiography as the reference standard.[1] However for the diagnosis and monitoring of LVV activity in LVV the imaging modalities are not yet uniformly used and up to now the evidences on the role for outcome prediction are limited.[2] According to recommendations 2018 of European League Against Rheumatism (EULAR) for the use of imaging in LVV:[3]

  • in patients suspected for TA, MRI should be used as the first imaging test to investigate mural inflammation and/or luminal changes and make a diagnosis of TA.
  • in patients with LVV the imaging is not routinely recommended for patients in clinical and biochemical remission. If a flare is suspected, the imaging might be helpful to confirm or exclude it.
  • in patients with LVV, all imaging modalities may be used for detecting stenosis, occlusion, dilatation and/or aneurysms and long-term monitoring of structural damage.


We report our experience on the imaging in TA. A 62-year-old Caucasian woman, heavy smoker, with body mass index of 28 kg/m2, without metabolic and immunological diseases history, suffering from hypertensive disease, was referred to nephrology department for evaluation of bilateral renal arteries stenosis and severe arterial hypertension. Doppler ultrasound, CT-angiography and MRA identified bilateral carotid atheromasia without hemodynamic relevance and left proximal subclavian arterys tenosis with flow reversal in left vertebral artery [Figure 1]. MRA identified occlusion of left proximal subclavian artery and intense mural edema [Figure 2]. Renal arteries arteriography showed severe bilateral stenosis [Figure 3]. On physical examination, we found tensive difference between arms (40 mm Hg > on the right arm), decreased left brachial artery pulse and a vascular bruit on the left side of her neck. Immunological and microbiological investigations were negative; blood count, proteinuria, renal function, glycemia and lipid metabolism tests were in the normal ranges; PCR 0.67. The cardiac performance was normal. Fundus oculi showed initial hypertensive retinopathy. The patient met four of six ACR criteria and of five of six EULAR criteria for TA classification. She underwent transcutaneous balloon angioplasty of renal arteries with bilateral stenting. Prompt diagnosis and treatment are important to prevent serious ischemic events in LVV. In the current literature, MRA has been extensively used for evaluating vascular inflammation. MRA is a heplful diagnostic tool in patients suspected for TA but, as reported in the clinical practice, there is an evident need to identify newer and more effective clinical-radiological indexes for monitoring the TA biological activity.[4]
Figure 1: MRI showing occlusion of left proximal subclavian artery with flow reversal in the left vertebral artery.

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Figure 2: Contrast-enhanced MR-angiography: mural edema of the left proximal subclavian artery wall.

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Figure 3: Abdominal angiography: bilateral stenosis of renal arteries.

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Conflict of interest: None declared.



 
   References Top

1.
Yamada I, Nakagawa T, Himeno Y, Kobayashi Y, Numano F, Shibuya H. Takayasu arteritis: diagnosis with breath-hold contrast-enhanced three-dimensional MR angiography. J Magn Reson Imaging 2000;11:481-7.  Back to cited text no. 1
    
2.
Duftner C, Dejaco C, Sepriano A, Falzon L, Schmidt WA, Ramiro S. Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and meta-analysis informing the EULAR recommendations. RMD Open 2018;4:e000612.  Back to cited text no. 2
    
3.
Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinicalpractice. Ann Rheum Dis 2018;77:636-43.  Back to cited text no. 3
    
4.
Li Cavoli G, Mulè G, Vallone MG, Caputo F. Takayasu’s disease effects on the kidneys: current perspectives. Int J Nephrol Renovasc Dis 2018;11:225-33.  Back to cited text no. 4
    

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Correspondence Address:
Gioacchino Li Cavoli
Department of Nephrology, Dialysis and Renal Transplant, ARNAS Civico and Di Cristina Hospital, Palermo
Italy
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DOI: 10.4103/1319-2442.318537

PMID: 34145144

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  [Figure 1], [Figure 2], [Figure 3]



 

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