Imaging

Vasculitis

Preliminary Diagnosis: Vasculitis

I. What imaging technique is first-line for this diagnosis?

MR imaging (with and without contrast) of the area of concern. MRA (with and/or without contrast) imaging may additionally be performed.

II. Describe the advantages and disadvantages of this technique for diagnosing vasculitis.

Advantages

  • Highly sensitive and specific in detecting, detailing, and characterizing vasculitis.

  • Does not expose patients to ionizing radiation.

  • May be performed per time of flight protocol without contrast in those who cannot receive contrast.

Disadvantages

  • Expensive.

  • Time consuming.

  • May be subject to motion artifact and susceptibility weighted artifact, degrading image quality.

  • Contraindicated in patients who have non-MR compatible hardware.

III. What are the contraindications for the first-line imaging technique?

MR imaging is contraindicated in patients with non-MR compatible hardware.

IV. What alternative imaging techniques are available?

  • Contrasted CT/CTA of the area of concern.

  • Catheter angiography.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing vasculitis.

Contrasted CT/CTA of the area of concern

Advantages

  • Relatively quick imaging modality.

  • May help guide treatment and therapy.

  • Offers great detail of the surrounding soft tissues, osseous structures, and vasculature.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Somewhat limited in sensitivity and specificity in characterizing the vascular structures.

Catheter angiography

Advantages

  • Gold standard for detecting, detailing, and characterizing vasculitis.

  • May help guide biopsy and treatment.

Disadvantages

  • May expose patients to large amounts of ionizing radiation.

  • Increased morbidity and mortality associated with an invasive procedure.

VI. What are the contraindications for the alternative imaging techniques?

Contrasted CT/CTA of the area of concern

  • May be contraindicated in pregnant patients, those in renal failure, and those on an inadequate dialysis regimen.

  • May be contraindicated in patients with a contrast allergy.

Catheter angiography

  • Contraindicated in those in a severe hypocoaguable state.

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