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Contrast-enhanced ultrasound may be effective in diagnosing large vessel vasculitis
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Carotid contrast-enhanced ultrasound vascularization grade and grade of vascular inflammation shown on 18F-FDG positron emission tomography correlated well in patients with large vessel vasculitis, according to recently published research.
Researchers enrolled 31 patients with large vessel vasculitis (LVV), including four patients who were evaluated twice over a 12-month period. Standard color Doppler ultrasound (CDUS) evaluations of extra-cranial carotid arteries were administered to all patients and intima media thickness was measured at the far wall of both carotid arteries in proximity to the bifurcation. Vasculitis was determined in the presence of a hypoechoic, circumferential homogenous wall thickening, while inhomogenous, eccentric, thickening of the partly calcified arterial wall was deemed athermatosis. Criteria defined by Drielsma et al was used to define atherosclerotic
carotid plaques.
Within 5 to 10 seconds following the standard CDUS examination, an ultrasound contrast agent was infused to assess the right carotid artery with contrast-enhanced ultrasound (CEUS) and the degree of vascularization was classified.
Within 3 days of CEUS evaluation, patients underwent 18F-FDG PET/CT scans after fasting for 4 or more hours prior to injection.
Erythrocyte sedimentation rates and C-reactive protein were elevated during the testing point in 19 of the examinations. Abnormal vascular uptake was demonstrated in 10 examinations in the right carotid artery and in different vascular areas in nine examinations.
Patients with grade 2 vascularization at CEUS were more likely to have intima media thickness above 1 mm and FDG carotid uptake of 2 or greater and the maximum standardized uptake value (SUV) and the mean SUV in the right carotid artery and mean SUV in the superior vena cava were significantly higher in patients with severe vascularization on CEUS.
“In conclusion, CEUS is a cheap, non-invasive tool useful to examine large vessel wall vascularization in LVV,” the researchers wrote. “The correlation between CEUS and 18F-FDG uptake suggests an association between vascularization and inflammation and supports the use of CEUS as a noninvasive method able to detect disease activity in patients with LVV.” – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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