Assessment of activity of Takayasu arteritis by contrast-enhanced ultrasonography

doi:10.3877/cma.j.issn.1672-6448.2021.01.008

Abstract

Abstract:

Objective

To investigate the correlation between clinical activity and the enhancement of vessel wall acquired by contrast-enhanced ultrasound sonography (CEUS) in patients with Takayasu arteritis (TA), and to evaluate whether CEUS can be used to assess the disease activity of TA.

Methods

A total of 37 TA patients with 62 carotid arteries affected were enrolled form January 2019 to January 2020 retrospectively at Xuanwu Hospital of Capital Medical University. The patients were divided into either an active group (17 patients) or an inactive group (20 patients) for statistical analysis. Contrast-enhanced ultrasound combined with clinical manifestations and laboratory results were used to analyze the characteristics of carotid artery wall structure in the two groups, as well as the correlation of parameters of contrast-enhanced ultrasound and inflammatory factors.

Results

In the 37 patients, a total of 62 carotid arteries were involved, including 28 carotid arteries in the active group and 34 in the inactive group. Erythrocyte sedimentation rate (ESR) (Z=-2.12, P=0.03) and C-reactive protein (CRP) (t=2.54, P=0.02) in the active group were significantly higher than those in the inactive group.The carotid wall thickness (t=0.60, P=0.55) and stenotic severity (χ²=0.63, P=0.43) assessed had no significant difference between the two groups (P＞0.05). The neovascularization detected by CEUS in the active group was significantly higher than that in the inactive group (χ²=10.42, P＜0.01). The slope of CEUS time-intensity curve (Z=1.75, P＜0.01), peak intensity (Z=1.62, P=0.03), and area under curve (Z=2.01, P＜0.01) in the active group were significantly increased, and the time to peak (t=-4.24, P＜0.01) in the active group was significantly shorter than that in the inactive group.CRP was positively correlated with slope (r=0.51, P＜0.01), PI (r=0.49, P＜0.01), and AUC (r=0.49, P＜0.01), and negatively correlated with TTP (r=-0.63, P＜0.01). ESR was also positively correlated with slope (r=0.51, P＜0.01), PI (r=0.47, P＜0.01) and AUC (r=0.55, P＜0.01), and negatively correlated with TTP (r=-0.72, P＜0.01).

Conclusion

The neovascularization assessed by CEUS is highly related to the TA activity, and peak intensity of CEUS is significantly correlated with inflammatory factors. CEUS could be used as an alternative imaging method to assess disease activity for TA patients, and can provide a basis for clinicians to formulate the best treatment plan.

Key words: Carotid arteries, Takayasu arteritis, Contrast-enhanced ultrasound

Ran Liu, Jingzhi Li, Mingyu Xia, Xinyu Zhao, Liyong Du, Yang Hua. Assessment of activity of Takayasu arteritis by contrast-enhanced ultrasonography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(01): 33-39.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.01.008

https://chaosheng.cma-cmc.com.cn/EN/Y2021/V18/I01/33

Figures/Tables 6

参数	活动期组（n=17）	非活动期组（n=20）	统计值	P值
年龄（岁， $x ¯$ ±s）	42.52±14.4	37.80±16.73	t=-0.99	0.33
女性[例（%）]	17（100.00）	19（95.00）	χ²=-0.87	0.99
BMI（kg/m²， $x ¯$ ±s）	23.24±3.15	23.67±3.63	t=-0.38	0.70
MBP（mmHg， $x ¯$ ±s）	87.4±13.6	86.5±12.1	t=0.22	0.83
过敏史[例（%）]	0（0.00）	1（5.00）	-	0.99
家族史[例（%）]	0（0.00）	2（10.00）	-	0.39
头晕[例（%）]	9（52.94）	5（25.00）	χ²=3.05	0.08
肢体运动障碍[例（%）]	5（29.41）	5（25.00）	χ²=0.09	0.76
双上肢血压不对称[例（%）]	3（17.64）	0（0.00）	-	0.09
无脉[例（%）]	3（17.64）	3（15.00）	-	0.59
颈部疼痛[例（%）]	2（11.76）	2（10.00）	-	0.63
发热[例（%）]	4（23.53）	0（0.00）	-	0.04
肌骨疼痛[例（%）]	3（17.64）	0（0.00）	-	0.09
既往用药史[例（%）]	12（70.59）	14（70.00）	χ²=0.00	0.97
皮质类固醇[例（%）]	12（70.59）	13（65.00）	χ²=0.13	0.72
甲氨蝶呤[例（%）]	8（47.06）	9（45.00）	χ²=0.02	0.90
氯吡格雷[例（%）]	3（17.64）	6（30.00）	-	0.46
阿司匹林[例（%）]	7（41.18）	10（50.00）	χ²=0.29	0.59
他汀[例（%）]	5（29.41）	9（45.00）	χ²=0.95	0.33
IgA[mg/L，M（Q_R）]	2.67（1.27，4.75）	1.64（1.16，2.42）	Z=-1.68	0.10
IgG[mg/L， $x ¯$ ±s]	13.52±4.43	11.33±2.92	t=1.80	0.08
IgM[mg/L， $x ¯$ ±s]	1.55±0.71	1.24±0.45	t=1.60	0.12
补体C3[g/L， $x ¯$ ±s]	0.97±0.21	0.86±0.14	t=1.84	0.08
补体C4[g/L， $x ¯$ ±s]	0.26±0.07	0.23±0.08	t=1.43	0.16
CRP[mg/L， $x ¯$ ±s]	25.25±6.56	29.76±6.01	t=2.54	0.02
ESR[mm/h，M（Q_R）]	25.00（9.01，65.50）	10.50（8.00，22.00）	Z=-2.12	0.03

参数	活动期组（n=17）	非活动期组（n=20）	统计值	P值
年龄（岁， $x ¯$ ±s）	42.52±14.4	37.80±16.73	t=-0.99	0.33
女性[例（%）]	17（100.00）	19（95.00）	χ²=-0.87	0.99
BMI（kg/m²， $x ¯$ ±s）	23.24±3.15	23.67±3.63	t=-0.38	0.70
MBP（mmHg， $x ¯$ ±s）	87.4±13.6	86.5±12.1	t=0.22	0.83
过敏史[例（%）]	0（0.00）	1（5.00）	-	0.99
家族史[例（%）]	0（0.00）	2（10.00）	-	0.39
头晕[例（%）]	9（52.94）	5（25.00）	χ²=3.05	0.08
肢体运动障碍[例（%）]	5（29.41）	5（25.00）	χ²=0.09	0.76
双上肢血压不对称[例（%）]	3（17.64）	0（0.00）	-	0.09
无脉[例（%）]	3（17.64）	3（15.00）	-	0.59
颈部疼痛[例（%）]	2（11.76）	2（10.00）	-	0.63
发热[例（%）]	4（23.53）	0（0.00）	-	0.04
肌骨疼痛[例（%）]	3（17.64）	0（0.00）	-	0.09
既往用药史[例（%）]	12（70.59）	14（70.00）	χ²=0.00	0.97
皮质类固醇[例（%）]	12（70.59）	13（65.00）	χ²=0.13	0.72
甲氨蝶呤[例（%）]	8（47.06）	9（45.00）	χ²=0.02	0.90
氯吡格雷[例（%）]	3（17.64）	6（30.00）	-	0.46
阿司匹林[例（%）]	7（41.18）	10（50.00）	χ²=0.29	0.59
他汀[例（%）]	5（29.41）	9（45.00）	χ²=0.95	0.33
IgA[mg/L，M（Q_R）]	2.67（1.27，4.75）	1.64（1.16，2.42）	Z=-1.68	0.10
IgG[mg/L， $x ¯$ ±s]	13.52±4.43	11.33±2.92	t=1.80	0.08
IgM[mg/L， $x ¯$ ±s]	1.55±0.71	1.24±0.45	t=1.60	0.12
补体C3[g/L， $x ¯$ ±s]	0.97±0.21	0.86±0.14	t=1.84	0.08
补体C4[g/L， $x ¯$ ±s]	0.26±0.07	0.23±0.08	t=1.43	0.16
CRP[mg/L， $x ¯$ ±s]	25.25±6.56	29.76±6.01	t=2.54	0.02
ESR[mm/h，M（Q_R）]	25.00（9.01，65.50）	10.50（8.00，22.00）	Z=-2.12	0.03

超声特征		活动期组（n=28）	非活动期组（n=34）	统计值	P值
常规超声
管壁厚度（mm， $x ¯$ ±s）		2.46±1.01	2.32±0.79	t=0.60	0.55
狭窄程度[支（%）]				χ²=0.63	0.43
	＜70%	12（42.86）	18（52.94）
	≥70%	16（57.14）	16（47.06）
超声造影
新生血管2级[支（%）]		17（60.71）	7（20.59）	χ²=10.42	＜0.01
达峰曲线斜率[M（Q_R）]		7.27（4.47,13.17）	3.40（1.99,7.54）	Z=1.75	＜0.01
达峰时间（s， $x ¯$ ±s）		17.75±5.98	25.30±8.00	t=-4.24	＜0.01
峰值强度[dB，M（Q_R）]		31.33（16.59，50.86）	14.28（11.17，25.62）	Z=1.62	0.03
曲线下面积[M（Q_R）]		641.37（448.30，932.48）	283.72（158.49，476.35）	Z=2.01	＜0.01

超声特征		活动期组（n=28）	非活动期组（n=34）	统计值	P值
常规超声
管壁厚度（mm， $x ¯$ ±s）		2.46±1.01	2.32±0.79	t=0.60	0.55
狭窄程度[支（%）]				χ²=0.63	0.43
	＜70%	12（42.86）	18（52.94）
	≥70%	16（57.14）	16（47.06）
超声造影
新生血管2级[支（%）]		17（60.71）	7（20.59）	χ²=10.42	＜0.01
达峰曲线斜率[M（Q_R）]		7.27（4.47,13.17）	3.40（1.99,7.54）	Z=1.75	＜0.01
达峰时间（s， $x ¯$ ±s）		17.75±5.98	25.30±8.00	t=-4.24	＜0.01
峰值强度[dB，M（Q_R）]		31.33（16.59，50.86）	14.28（11.17，25.62）	Z=1.62	0.03
曲线下面积[M（Q_R）]		641.37（448.30，932.48）	283.72（158.49，476.35）	Z=2.01	＜0.01

超声造影参数	CRP		ESR
超声造影参数	r值	P值	r值	P值
达峰曲线斜率	0.51	＜0.01	0.51	＜0.01
达峰时间	-0.63	＜0.01	-0.72	＜0.01
峰值强度	0.49	＜0.01	0.47	＜0.01
曲线下面积	0.49	＜0.01	0.55	＜0.01

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