Contrast-enhanced ultrasonography in Takayasu arteritis: watching and monitoring the arterial inflammation

Abstract

A 43-year-old man was diagnosed with Takayasu arteritis, and treated with methotrexate and corticosteroids. While under treatment and with normal biological inflammatory parameters, he experienced an ischaemic stroke, successfully treated with intravenous thrombolysis (alteplase). The B-mode ultrasound examination revealed circumferential wall thickening of the left common carotid artery. Contrast-enhanced ultrasonography showed a progressive arterial wall enhancement of the left common carotid artery. This pathological enhancement indicates neovascularisation of the arterial wall, which is supposed to correlate with active vascular inflammation. After an increase in immunosuppressive treatment, follow-up contrast-enhanced ultrasonography no longer showed artery wall enhancement. Contrast-enhanced ultrasound examination is an inexpensive, reproducible and minimally invasive method, providing dynamic information on arterial wall neovascularisation and thus inflammation. This case illustrates that contrast-enhanced ultrasonography can be a useful tool for the management and follow-up of Takayasu arteritis, and its use as a marker of disease activity and arterial inflammation in Takayasu arteritis should be evaluated in further studies.

Figure 1

Initial contrast-enhanced ultrasonography of the left common carotid artery; (A) longitudinal and (B) transverse sections. Star indicates arterial lumen filled with contrast agent and arrows show microbubbles in the wall thickness, trapped in the vasa vasorum, indicating neovascularisation of the arterial wall, which correlates with the degree of vascular inflammation.

Figure 2

Follow-up contrast-enhanced ultrasonography of the left common carotid artery 3 months after the ischaemic event; (A) longitudinal and (B) transverse sections. Star indicates arterial lumen filled with contrast agent and triangles show no microbubbles in the wall thickness.