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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
› Institutsangaben
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Publikationsverlauf

21. September 2018

28. November 2018

Publikationsdatum:
23. Januar 2019 (online)

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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
 

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