Delayed Contrast-Enhanced MRI of the Coronary Artery Wall in Takayasu Arteritis

BackgroundTakayasu arteritis (TA) is a rare form of chronic inflammatory granulomatous arteritis of the aorta and its major branches. Late gadolinium enhancement (LGE) with magnetic resonance imaging (MRI) has demonstrated its value for the detection of vessel wall alterations in TA. The aim of this study was to assess LGE of the coronary artery wall in patients with TA compared to patients with stable CAD. MethodsWe enrolled 9 patients (8 female, average age 46±13 years) with proven TA. In the CAD group 9 patients participated (8 male, average age 65±10 years). Studies were performed on a commercial 3T whole-body MR imaging system (Achieva; Philips, Best, The Netherlands) using a 3D inversion prepared navigator gated spoiled gradient-echo sequence, which was repeated 34–45 minutes after low-dose gadolinium administration. ResultsNo coronary vessel wall enhancement was observed prior to contrast in either group. Post contrast, coronary LGE on IR scans was detected in 28 of 50 segments (56%) seen on T2-Prep scans in TA and in 25 of 57 segments (44%) in CAD patients. LGE quantitative assessment of coronary artery vessel wall CNR post contrast revealed no significant differences between the two groups (CNR in TA: 6.0±2.4 and 7.3±2.5 in CAD; p = 0.474). ConclusionOur findings suggest that LGE of the coronary artery wall seems to be common in patients with TA and similarly pronounced as in CAD patients. The observed coronary LGE seems to be rather unspecific, and differentiation between coronary vessel wall fibrosis and inflammation still remains unclear.背景：高安动脉炎（Takayasu arteritis, TA）是一类累及主动脉及其主要分支的罕见慢性肉芽肿性炎性动脉炎。磁共振成像（magnetic resonance imaging, MRI）联合钆延迟增强（Late gadolinium enhancement, LGE）技术已被证实可用于检测TA患者的血管壁异常改变。本研究旨在对比TA患者与稳定型冠状动脉疾病（stable CAD）患者的冠状动脉壁钆延迟增强表现。方法：本研究纳入9名经确诊的TA患者（8例女性，平均年龄46±13岁）；冠心病组纳入9名患者（8例男性，平均年龄65±10岁）。所有扫描均采用商用3T全身磁共振成像系统（Achieva；飞利浦，荷兰贝斯特），使用3D反转准备导航门控扰相梯度回波序列，并在低剂量钆剂给药后34~45分钟重复扫描。结果：两组患者造影前均未观察到冠状动脉壁强化。造影后，TA组在T2预扫序列中显示的50个冠状动脉节段里，有28个（56%）在反转恢复（IR）扫描中检出冠状动脉LGE；冠心病组的57个节段中则有25个（44%）检出。对造影后冠状动脉血管壁对比噪声比（CNR）的定量评估显示，两组间无显著统计学差异（TA组CNR为6.0±2.4，冠心病组为7.3±2.5；p=0.474）。结论：本研究结果提示，冠状动脉壁钆延迟增强在TA患者中较为常见，其表现程度与冠心病患者相仿。本次观察到的冠状动脉LGE特异性较低，冠状动脉血管壁纤维化与炎症的鉴别仍有待明确。