Diagnostic value of contrast-enhanced magnetic resonance angiography in large-vessel vasculitis.
To evaluate contrast-enhanced magnetic resonance angiography (MRA) in diagnosis of inflammatory aortic involvement in patients with clinical suspicion of large-vessel vasculitis.



Seventy-five patients, mean age 62 years (range 16-82 years), 44 female and 31 male, underwent gadolinium-enhanced MRA and were evaluated retrospectively. Thoracic MRA was performed in 32 patients, abdominal MRA in 7 patients and both thoracic and abdominal MRA in 36 patients. Temporal arterial biopsies were obtained from 22/75 patients. MRA positivity was defined as increased aortic wall signal in late gadolinium-enhanced axial turbo inversion recovery magnitude (TIRM) series. The influence of prior glucocorticoid intake on MRA outcome was evaluated.



MRA was positive in 24/75 patients, with lesions located in the thorax in 7 patients, the abdomen in 5 and in both thorax and abdomen in 12. Probability for positive MRA after glucocorticoid intake for more than 5 days before MRA was reduced by 89.3%. Histology was negative in 3/10 MRA-positive patients and positive in 5/12 MRA-negative patients. All 5/12 histology positive / MRA-negative patients had glucocorticoids for >5 days prior to MRA and were diagnosed as having vasculitis. Positive predictive value for MRA was 92%, negative predictive value was 88%.



Contrast-enhanced MRA reliably identifies large vessel vasculitis. Vasculitic signals in MRA are very sensitive to glucocorticoids, suggesting that MRA should be done before glucocorticoid treatment.
Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Switzerland.
Sabine
S
Adler
Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Switzerland.
Marco
M
Sprecher
Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Switzerland.
Felix
F
Wermelinger
Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital and University of Bern, Switzerland; Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Germany.
Thorsten
T
Klink
Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital and University of Bern, Switzerland.
Harald
H
Bonel
Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Switzerland.
Peter M
PM
Villiger
D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage; D006801:Humans; D007089:Image Enhancement; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014657:Vasculitis / Q000175:diagnosis* / Q000000981:diagnostic imaging
D003287:Contrast Media; D005682:Gadolinium