Delayed contrast-enhanced magnetic resonance imaging enables detection of pulmonary artery lesions in Takayasu's arteritis

Xiaojuan Guo; Min Liu; Mingxi Liu; Zhanhong Ma; Juanni Gong; Yuanhua Yang; Wei Gao; Jiaoyan Wu; Qi Yang; Min-Fu Yang

doi:10.21037/qims-22-130

Delayed contrast-enhanced magnetic resonance imaging enables detection of pulmonary artery lesions in Takayasu's arteritis

Quant Imaging Med Surg. 2023 Jan 1;13(1):145-159. doi: 10.21037/qims-22-130. Epub 2022 Nov 24.

Authors

Xiaojuan Guo¹, Min Liu², Mingxi Liu¹, Zhanhong Ma¹, Juanni Gong³, Yuanhua Yang³, Wei Gao⁴, Jiaoyan Wu⁵, Qi Yang^#¹, Min-Fu Yang^#⁵

Affiliations

¹ Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
² Department of Radiology, China-Japan Friendship Hospital, Beijing, China.
³ Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
⁴ Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
⁵ Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

^# Contributed equally.

Abstract

Background: Delayed contrast-enhanced magnetic resonance imaging (DE-MRI) is a useful technique to identify arterial wall inflammation. The aim of this study was to explore the value of DE-MRI in the evaluation of pulmonary artery (PA) lesions in Takayasu's arteritis (TAK) compared with ¹⁸F-fuorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT).

Methods: Patients with TAK were recruited for this prospective, observational study. Imaging and clinical assessments were performed concurrently. Only thoracic arteries were evaluated, and they were divided into 18 segments per person. All arterial lesions were evaluated using both PET/CT and DE-MRI. Correlations between both methods were assessed in the PA and thoracic aorta. A receiver operating characteristic (ROC) curve was used to analyze the value of imaging features in detecting disease activity based on National Institutes of Health (NIH) criteria.

Results: A total of 24 patients contributed 432 arterial segments. Using PET/CT, correlations between arterial wall DE, thickening, and edema in the PA were 84.52%, 67.92%, and 58.33%, respectively, with Cohen's kappa =0.69, 0.30, and 0.13, respectively; for the thoracic aorta, the values were 86.38%, 80.00%, and 75.92%, respectively, with Cohen's kappa =0.71, 0.52, and 0.372, respectively. There was a significant difference in the incidence of wall DE between the PA and thoracic aorta in patients with clinically active TAK (χ²=6.85, P=0.009). DE-MRI presented a higher area under the curve [area under the curve (AUC); 0.729, P=0.047] than wall thickening and edema in the detection of TAK activity. The wall DE combined with erythrocyte sedimentation rate (ESR) showed improved efficiency (AUC: 0.858, P=0.003).

Conclusions: DE-MRI displays appreciable correlations with PET/CT findings and allows for the detection of PA inflammation in patients with TAK; it shows higher values in the thoracic aorta than in the PA. The combination of wall DE and ESR can improve the efficiency of assessing disease status.

Keywords: Delayed contrast-enhanced magnetic resonance imaging (DE-MRI); Takayasu’s arteritis (TAK); fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT); pulmonary artery (PA).