title: MRI parametric monitoring of biological therapies in primary large vessel vasculitides: a pilot study.
abstract: OBJECTIVE
  To evaluate the development of characteristic MRI changes in patients with primary large-vessel vasculitis (LVV) when treated with biological therapies.
  
  
  METHODS
  12 patients with primary LVV (8 patients with Takayasu arteritis and 4 patients with giant-cell arteritis) received biological therapy with tumour necrosis factor-α blockers (n = 9) or an interleukin-6 inhibitor (n = 3). MRI investigations were performed at baseline (pre-treatment) and follow-up. All patients underwent the same MRI/MR angiography (MRA) protocol. Laboratory parameters (C-reactive protein and erythrocyte sedimentation rate) and clinical response (Birmingham Vasculitis Activity Score) were assessed.
  
  
  RESULTS
  Wall thickness was 4.2 ± 0.3 mm pre-treatment and significantly decreased to 3.2 ± 0.3 mm post treatment in 9/12 patients. Mural enhancement was increased in all 12/12 patients with LVV, and subsided with therapy in 5/12 patients. Mural oedema or ill-defined contour were less prevalent but also improved with biological treatment. C-reactive protein and erythrocyte sedimentation rate levels decreased, and clinical assessment revealed a significant improvement from pre-treatment to post-treatment. However, the course of imaging characteristics often did not parallel that of laboratory or clinical parameters. In all three patients receiving interleukin-6 blockade, laboratory markers and clinical scores normalized despite persistent vascular inflammation in one patient which was disclosed by MRI.
  
  
  CONCLUSIONS
  Contrast-enhanced MRI/MRA may be useful when evaluating the development of disease activity in primary LVV under biological therapies. A high degree of suspicion and regular imaging follow-up is needed to detect persistent inflammation.
  
  
  CONCLUSIONS
  This is the first study investigating the applicability of different MRI/MRA parameters for monitoring biological therapy in patients with primary LVV.
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Spira
authors.affiliation: 2 Department of Internal Medicine II, Eberhard-Karls-University Tübingen, Tübingen, Germany.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xenitidis
authors.affiliation: 2 Department of Internal Medicine II, Eberhard-Karls-University Tübingen, Tübingen, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Henes
authors.affiliation: 3 Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tübingen, Tübingen, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001691:Biological Therapy; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D003287:Contrast Media; D005260:Female; D013700:Giant Cell Arteritis / Q000188:drug therapy*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D010865:Pilot Projects; D012189:Retrospective Studies; D013625:Takayasu Arteritis / Q000188:drug therapy*; D016896:Treatment Outcome; D000093242:Interleukin-6 Inhibitors
chemical_list: D000068879:Adalimumab; D000893:Anti-Inflammatory Agents; D002097:C-Reactive Protein; D003287:Contrast Media; D000069285:Infliximab; D009942:Organometallic Compounds; D000093242:Interleukin-6 Inhibitors; C090600:gadobutrol