Stenosis and Pseudostenosis of the Upper Extremity Arteries in Large-Vessel Vasculitis.
Stenosis and Pseudostenosis of the Upper Extremity Arteries in Large-Vessel Vasculitis.
复制标题
大血管血管炎中上肢动脉的狭窄和假性狭窄。
DOI：
10.1002/acr2.1018
复制
发表时间：
2019
影响因子：
3.4
通讯作者：
Grayson,PeterC
中科院分区：
文献类型：
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作者：
Marinelli,KathleenC;Ahlman,MarkA;Quinn,KaitlinA;Malayeri,AshkanA;Evers,Robert;Grayson,PeterC
目的假性狭窄是一种模拟动脉狭窄的磁共振血管造影（MRA）伪影。研究目的是比较大血管炎（LVV）患者（包括巨细胞动脉炎（GCA）和Takayasu动脉炎（TAK））狭窄和假性狭窄的影像学和临床表现。方法对LVV患者（健康或血管病变）行主动脉弓血管MRA检查。锁骨下动脉和腋窝动脉由两位独立的读者系统地评估狭窄和假性狭窄的存在。连续和延迟成像和临床评估用于确认可疑的假性狭窄。多变量回归分析用于确定血管造影病理与临床表现之间的关系。结果分析了来自GCA （n = 36）、TAK （n = 47）和比较者（n = 25）患者的184张MRA扫描图。锁骨下远端动脉仅在注射侧出现假性狭窄（184次扫描中有48次，占26%），假性狭窄长度较真狭窄短（25 mm比78 mm，P< 0.01）。假性狭窄的诊断率（GCA = 33%, TAK = 23%，比较者= 20%，P= 0.44）、疾病活动状态（P= 0.31）或治疗状态（P= 1.00）无差异。真正狭窄的百分比和长度与上肢脉搏和血压异常独立相关。调整长度和狭窄程度后，侧支动脉缺失与手臂跛行相关（优势比= 2.37，P= 0.03）。结论尽管假性狭窄可能被错误地解释为动脉狭窄，但影像学和相关临床特征可以帮助区分真正的疾病和动脉易感性伪影。此外，外周血管检查有助于确认疑似的真狭窄，因为血管造影病理的特定方面与左室血管检查异常有关。
ObjectivePseudostenosis is a magnetic resonance angiography (MRA) artifact that mimics arterial stenosis. The study objective was to compare imaging and clinical aspects of stenosis and pseudostenosis in a cohort of large‐vessel vasculitis (LVV), including giant‐cell arteritis (GCA) and Takayasu's arteritis (TAK).MethodsPatients with LVV and comparator conditions (healthy or vasculopathies) underwent MRA of the aortic arch vessels. The subclavian and axillary arteries were systematically assessed for presence of stenosis and pseudostenosis by two independent readers. Serial and delayed imaging and clinical assessments were used to confirm suspected pseudostenoses. Multivariable regression analyses were used to identify associations between angiographic pathology and clinical findings.ResultsOne hundred eighty‐four MRA scans were analyzed from patients with GCA (n = 36), TAK (n = 47), and comparators (n = 25). Pseudostenoses were frequently observed (48 of 184 scans, 26%) in the distal subclavian artery only on the side of injection and were shorter in length compared with true stenoses (25 mm vs 78 mm,P< 0.01). There was no difference in prevalence of pseudostenosis by diagnosis (GCA = 33%, TAK = 23%, comparator = 20%,P= 0.44), disease activity status (P= 0.31), or treatment status (P= 1.00). Percent and length of true stenosis were independently associated with pulse and blood pressure abnormalities in the upper extremity. Adjusting for length and stenosis degree, absence of collateral arteries was associated with arm claudication (odds ratio = 2.37,P= 0.03).ConclusionAlthough a pseudostenosis could be falsely interpreted as an arterial stenosis, radiographic and associated clinical features can help distinguish true disease from arterial susceptibility artifacts. In addition, the peripheral vascular examination can help to confirm a suspected true stenosis, as specific aspects of angiographic pathology are associated with vascular examination abnormalities in LVV.