COMPARATIVE ULTRASONOGRAPHIC AND ANGIOGRAPHIC STUDY OF CAROTID ARTERIAL LESIONS IN TAKAYASUS-ARTERITIS

The purpose of this study was to compare the usefulness of ultrasonogr aphy to that of angiography for studying arterial lesions in Takayasu' s arteritis. Ultrasonographic and angiographic findings from 44 caroti d arteries of 22 patients with Takayasu's arteritis (2 men and 20 wome n; mean age, 41.2 years) were compared. Angiography was used to classi fy the patency of the carotid arteries into three groups: nonstenotic, stenotic, and occlusive. Ultrasonography was also used to classify th e same arteries into four groups: nonstenotic, mildly stenotic, modera tely stenotic, and occlusive. Thickness of the wall (intima-media comp lex) of the carotid artery was measured with high-frequency transducer s. Angiography showed 23 carotid arteries to be nonstenotic; 12, steno tic; and 9, occlusive; whereas ultrasonography showed 16 to be nonsten otic; 18, mildly stenotic; 7, moderately stenotic; and 3, occlusive. R esults of the two diagnostic modalities correlated closely (P < 0.0001 ). Ultrasonography, aided by color flow imaging, detected six instance s of a marginal but definite blood flow that angiography had failed to reveal. Arterial wall thickness correlated closely with the severity of ultrasonographic stenosis (P < 0.005). This thickness was 1.3 +/- 0 .4 mm in the nonstenotic group, 1.6 +/- 0.5 mm in the mildly stenotic group, 2.2 +/- 0.8 mm in the moderately stenotic group, and 1.9 +/- 0. 2 mm in the occlusive group. Even the walls of the nonstenotic arterie s were significantly thicker than those of the normal carotid arteries (0.7 +/- 0.1 mm, P < 0.01). Ultrasonography appeared to be more usefu l than angiography in estimating stenotic severity of the carotid arte ry in Takayasu's arteritis. Characteristic ultrasonic findings include d luminal stenosis or occlusion on two-dimensional ultrasonograms, dec rease in or lack of flow shown by color Doppler flow imaging, and conc entric thickening of the carotid arterial walls. Ultrasonographic mura l thickness was the most sensitive indicator of early, latent inflamma tion.