Tobias Saam MD, Presenter: Research Grant, Diamed Medizintechnik GmbH Research Grant, Bayer AG

Stefan Maurus, Abstract Co-Author: Nothing to Disclose

Nora Navina Kammer MD, Abstract Co-Author: Nothing to Disclose

Karla Maria Treitl MD, Abstract Co-Author: Nothing to Disclose

Hendrik Kooijman, Abstract Co-Author: Employee, Koninklijke Philips NV

Eva Maria Coppenrath MD, Abstract Co-Author: Nothing to Disclose

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Although 2D-T1w black-blood sequences are able to detect atherosclerotic and inflammatory changes of thoracic vessels they are time extensive and thus offer limited coverage. We sought to evaluate a commercially not available isotropic 3D black-blood T1w-TSE sequence with variable flip angles (3D-T1-BB-VISTA) for the diagnosis of thoracic large vessel vasculitis.

14 patients with suspected large vessel vasculitis and 14 control patients without any evidence of vascular disease received a standardized protocol with a fat suppressed 3D-T1-BB-VISTA pre- and post contrast (resolution=0.8 mm3 isotropic, scan time 5-6 minutes) using a navigator and peripheral pulse unit triggering. Ascending and descending aorta, aortic arch, left and right subclavian arteries and pulmonary arteries (168 arterial segments) were evaluated by two experienced readers in consensus decision for the presence of concentric wall thickening and contrast enhancement of the vessel wall.

Acceptable image quality was achieved in 27 out of 28 exams (96.4%). 35 out of 84 (41.7%) arterial segments in patients with suspected vasculitis showed contrast enhancement and 27 out of 84 (32.1%) concentric wall thickening. Both findings were found in 8 distinct patients with clinically confirmed vasculitis. Only one out of 78 (1.3%) arterial segments of the control group showed concentric wall thickening and contrast enhancement. In 2 out of 14 patients with suspected vasculitis effusion and synovialitis were found in the shoulder joints, suggestive of polymyalgia rheumatica. Figure 1 shows images of a 76-year old male (#1) with giant cell arteritis and inflammatory activity in both subclavian arteries and synovialitis in the right shoulder and of a 28 year-old female (#2) with Takayasu arteritis and inflammatory activity in both pulmonary arteries.

Free breathing navigated black-blood MRI is feasible in less than 12 minutes scan time and allows to accurately diagnosing thoracic vasculitis. Future studies will be necessary to evaluate the utility of this sequence for monitoring of anti-inflammatory therapies.

Currently PET/CT is used as gold standard to diagnosing vasculitis of the aorta and the pulmonary arteries. Black-blood MRI has the potential to replace PET/CT as a diagnostic tool. This might be particularly useful in young patients in which ionizing radiation should be used with caution.

Saam, T, Maurus, S, Kammer, N, Treitl, K, Kooijman, H, Coppenrath, E, Reiser, M, 3D-Black-Blood 3T-MRI for the Diagnosis of Thoracic Large Vessel Vasculitis: A Feasibility Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013882.html