1. Diagnostic Approach for Angiitis and IVR : Pathology
Director of Research and Education1), Cerebrovascular and Neurology Center2)
National Hospital Organization, Fukuoka-Higashi Medical Center
Katsuo Sueishi1), Yasuhiro Kumai2), Ayaka Fukurono2)
This issue reviews the pathological characteristics of systemic angiitis syndrome, particularly of large- and medium-sized vessels, including Takayasu’s arteritis, giant cell arteritis, classical polyarteritis nodosa, Buerger’s disease and inflammatory abdominal aortic aneurysm, which interventional radiologists may have difficulty in differentiating from each other. As the recent advances in imaging technology allow us to assess vascular alterations, not only quantitatively but also qualitatively, mutual collaboration and communication between clinicians and pathologists are more necessary than ever for making more precise diagnoses of angiitis.
- Primary angiitis syndrome
- Chapel Hill Consensus
2. Cerebral Vasculitis and its Simulators : Diagnostic and Interventional Radiology
Department of Radiology, National Hospital Organization Nagasaki Medical Center
Hideki Ishimaru, Kazuaki Nakajima, Yohjiro Matsuoka, Ayami Sakamoto, Takayuki Sakugawa
Department of Radiology, Nagasaki University
Department of Radiology, Sasebo Municipal Hospital
Michiko Inuzuka, Seigo Kimura
Cerebral vasculitis, although rare in general, is an important cause of cerebral ischemia, because the treatment strategy is different from that of usual cerebral infarction. On the other hand, a variety of common and uncommon nonvasculitic disorders may mimic vasculitis angiographically or clinically. It is also important to distinguish these vasculitis simulators from true vasculitis in order to avoid the unnecessary and harmful side effects of corticosteroid and immunosuppressant, the mainstay of drug therapy for vasculitis. The diagnosis is often difficult. Angiography is expected to demonstrate the underlying vascular pathology ; however, many vasculitides affect small arteries beyond the spatial resolution of conventional angiography. The most important role of the diagnostic imaging is the identification of brain lesions consistent with cerebral vasculitis. Multiple lesions in more than one vascular territory should raise this suspicion, although no specific pattern for this entity exists. In large and medium-sized vessel vasculitis, MRI can directly demonstrate mural thickening and enhancement, which is considered to specific for active inflammation. We propose here a classification for cerebral vasculitis and simulators according to the size of the affected brain vessels, which would help us to make a differential diagnosis. We also review the endovascular techniques for this entity, and its indications.
- Cerebral vasculitis
- Vasculitis simulator
- Diagnostic imaging
3. Pulmonary Vasculitis
Radiopathological Science Department of Radiology, Yamaguchi Univercity Graduate School of Medicine
Nobuyuki Tanaka, Naofumi Matsunaga
Pulmonary vasculitis is classified based on the caliber of the vasculature by using the classification of Chapel Hill Consensus Conference (CHCC) held in 1992. In this article, small vessel vasculitis was mainly discussed. Imaging findings, especially high-resolution CT (HRCT) findings, of these entities are variable and nonspecific. Extensive ground-glass attenuation (GGA) and airspace consolidation is seen due to diffuse alveolar hemorrhage induced by capillaritis in microscopic polyangiitis (MPA), systemic lupus erythematosus (SLE), and Goodpasture’s syndrome. GGA and airspace consolidation tend to distribute in the inner and middle lung areas. Centrilobular opacities may be recognized due to hemorrhage along the centrilobular arteries. Multiple nodules or airspace consolidation with or without cavity are usually seen in Wegener’s granulomatosis. In Churg-Strauss syndrome, GGA and consolidation in the peripheral lung areas, which are the characteristic findings for eosinophilic lung diseases, may be the predominant finding. Nodules with CT-halo sign and thickening of the interlobular septa may sometimes be seen. It should be noted that diffuse alveolar hemorrhage is rare in Wegener’s granulomatosis and Churg-Strauss syndrome. Knowledge of these HRCT findings will facilitate correctly diagnosing pulmonary vasculitis among many diffuse infiltrative lung diseases.
- Small vessel vasculitis
- Antineutrophil cytoplasmic antibody（ANCA）
- High-resolution CT（HRCT）
4. Abdominal Vasculitis
Department of Radiology, Oita University Hospital
Hiro Kiyosue, Hiromu Mori, Fumito Okada, Shuichi Tanoue, Rieko Shuto, Yoshiko Sagara
Department of Internal Medicine, Oita University
Abdominal vasculitis is relatively rare but can involve all of the visceral vasculature in abdominal organs, causing various symptoms depending on the size of the involved vessels and the target organs. Intestinal hemorrhage or peritoneal/retroperitoneal hemorrhage occurs with aneurysm formation and ulceration secondary to vasculitis, which can be managed by adequate interventional techniques. Percutaneous balloon angioplasty is one of the effective treatments of renovascular hypertension due to Takayasu’s arteritis. In this article, the authors demonstrate general features of several vasculitis involving abdominal organs, and the role of diagnostic and interventional radiology.
5. Diagnosis and IVR -Aortic Disease
Department of Radiology, Nagasaki University Hospital
Hideyuki Hayashi, Ichiro Sakamoto, Eijun Sueyoshi, Masataka Uetani
The purpose of this paper is to describe in detail the imaging and clinical appearances of Takayasu arteritis, followed by a description of the clinical and imaging features of other forms of large-vessel vasculitis such as infected aneurysm, Behçet disease and inflammatory abdominal aneurysm. To become familiar with these conditions and imaging features is essential to make the correct diagnosis. Indications and some comments on endovascular treatment of these conditions are also given. Endovascular treatment offers a potentially less invasive alternative to surgery ; however, further investigation with longer-term follow-up is strongly recommended.
- Takayasu arteritis
6. Diagnosis and Treatment of Thrombophlebitis
Department of Radiology, Saitama Cardiovascular and Respiratory Center
Toshiko Hoshi, Tetsu Kanauchi, Hiroko Matsumoto, Miyuki Ueda
Superficial thrombophlebitis and deep venous thrombosis (DVT) are the same pathological entity.
Superficial thrombophlebitis is diagnosed by clinical symptoms, and so it does not need any diagnostic imaging. Some systemic diseases, such as Behçet disease and anti-phospholipid antibody syndrome are often associated with thrombophlebitis.
DVT is a common disease, and it is important to make an accurate diagnosis of DVT. Conventional venography used to be the gold-standard of DVT diagnosis, although low-invasive methods nowadays have become popular. In this paper we describe recent vascular imaging techniques of DVT, ultrasonography, CT and MRI, and treatment of DVT.
- Deep venous thrombosis（DVT）