Noninvasive cerebrovascular assessment of Takayasu arteritis

Background and Purpose-Despite prominent neurological symptoms reported in Takayasu arteritis (TA), a complete evaluation of the cerebral circulation has not been consistently performed. The purpose of this study is to descri be MR angiography (MRA), color Doppler flow imaging, and transcranial Doppl er (TCD) findings in the extracranial and intracranial cerebral arteries in TA. Methods-MRA, color Doppler flow imaging, and TCD were performed in 21 patie nts with TA. Intima-media thickness was measured in the common carotid arte ry. The correlation between noninvasive studies and panaorto-arteriography was examined for supraortic vessels. Cerebral angiography findings were com pared with the noninvasive methods in 7 patients. Intracranial hemodynamic changes detected by TCD were compared with extracranial circulation lesions assessed by panaorto-arteriography. Results-Noninvasive vascular techniques showed at least 1 abnormality in th e extracranial and/or intracranial cerebral arteries in 20 of 21 patients ( 95%). Both MRA and color Doppler flow imaging showed a substantial correlat ion in the ability to detect obstructive lesions in supra-aortic vessels co mpared with panaorto-arteriography. High-resolution ultrasonography display ed common carotid artery wall thickening in 5 vessels that were considered normal by arteriography. In 24% of patients, MRA and TCD showed abnormaliti es consistent with stenosis of the basal cerebral arteries. In 10 patients with severe extracranial circulation involvement (detected by arteriography ), TCD displayed intracranial hemodynamic changes consisting of dampened or blunted waveforms with low pulsatility. Conclusions-The comprehensive assessment of cerebral circulation in TA pati ents by noninvasive methods allowed the detection of a high rate of diverse vascular abnormalities in both extracranial and intracranial circulation.