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Takayasu Arteritis Imaging

Practice Essentials

Takayasu arteritis is a granulomatous vasculitis of unknown etiology that commonly affects the thoracic aorta and its branches, the pulmonary arteries, and the coronary arteries. It causes intimal fibroproliferation, which ultimately leads to segmental stenosis, occlusion, dilatation, and aneurysmal formation in these vessels.
 In North America, Takayasu arteritis has an incidence of 2.6 per million population.
 Ninety percent of patients with Takayasu arteritis are younger than 30 years.

Imaging is considered the cornerstone of the diagnosis of Takayasu arteritis.
Historically, angiography has been the criterion-standard imaging tool for the diagnosis and evaluation of Takayasu arteritis. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have become equally valuable tools. Their large fields of view, as well as the fact that they are noninvasive, make them far more attractive as diagnostic tools. The increasing resolution of multidetector-row CT arrays increases the diagnostic value. The soft tissue differentiation possible with MR techniques is valuable in distinguishing active forms of Takayasu disease from quiescent forms.

Mavrogeni and colleagues  suggested a practical approach for the diagnosis of Takayasu arteritis and selection of imaging methods, as follows

CT and MRI for luminography are less invasive than angiography and depict similar results

Use MRI if possible over CT because of lack of radiation

Evaluate the heart; MRI is superior

Ultrasound is excellent for evaluating extracranial carotid arteries

Use PET if the main complaint is fever of unknown origin

Choose PET/MRI over PET/CT or PET

Correlate with imaging findings with clinical and laboratory findings

See the image of Takayasu arteritis below.

A 48-year-old woman with Takayasu disease. Note th

A 48-year-old woman with Takayasu disease. Note the narrowing of the origin of the right subclavian artery and a narrowed small vessel with subsequent aneurysmal dilatation on the right side.

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