非侵入式造影對高安動脈炎有助益


  July 22, 2004 -根據八月份類風濕疾病年報所發表的研究指出,非侵入式造影對高安動脈炎(TA)有助益。
  
  來自英國倫敦Hammersmith醫院和Imperial 學院的J. Andrews指出,TA是一種罕見疾病,對於早期診斷及療效評估仍是一個問題;TA症狀為非特定性,且傳統的血液檢查是不可信賴的,面對標準的急性期反應,通常持續伴隨血管發炎;目前最佳的診斷工具X光血管攝影是侵入性的,且只能確認血管晚期的結構上變化,近來非侵入性影像方法,在評估高安動脈炎病患上是大有前途的。
  
  研究人員審視侵入式及非侵入式造影運用於1996年至2002年間Hammersmith醫院風濕科的所有符合美國風濕病學會TA尺度的所有患者,當被診斷為TA時,所有患者表現出臨床上進行性發展中的病症,並接受口服prednisolone和輔以口服或注射免疫抑制劑治療;非侵入式造影研究是[18F]fluorodeoxyglucose陽電子放射斷層攝影術([18F]FDG-PET)及核磁共振造影術(MRI)。
  
  和X光血管造影法相比較,[18F]FDG-PET相對可提供對於疾病較重要之附加資訊,而MRI則提供對於血管壁增生疾病發展病程方面較重要附加之資訊。
  
  研究人員強調,之前一些磁共振造影術研究對超過15%的狹窄程度過度評價報導,在核磁造影術中的血管壁上顯現或不顯現的gadolinium元素增加,對疾病的活動並不是一可靠的指南,且傳統造影術所發現到的解剖學上的變化,對血管壁的水腫顯現或不顯現並不一定完全相關;在此試驗中,PET血管造影術,當血管壁攝入[18F]FDG,對疾病的活動是較佳的指標。
  
  研究人員指出,非侵入式造影術對TA疾病提供診斷及治療上有用的附加資訊,此技術比傳統的臨床判斷及/或血管造影術較能提供早期診斷及較正確的療效評估;研究人員並建議,能針對這做更進一步的大型臨床試驗。
  
  非侵入式造影術可能提供對其他血管炎疾病的治療助益;將來[18F]FDG-PET和MRI可作為診斷TA時被考慮到的標準研究,且其終將取代動脈內血管造影術,成為大部分患者需要的診斷方式。

Noninvasive Imaging Beneficial

By Laurie Barclay, MD
Medscape Medical News

July 22, 2004 — Noninvasive imaging is beneficial in Takayasu's arteritis (TA), according to the results of a study published in the August issue of the Annals of the Rheumatic Diseases.

“TA is a rare disease, in which early diagnosis and assessment of treatment efficacy remain a problem. Signs and symptoms may be non-specific and conventional blood tests unreliable, with vascular inflammation often persisting in the face of a normal acute phase response,” write J. Andrews, from Imperial College and Hammersmith Hospital in London, U.K., and colleagues. “The current ‘gold standard’ investigation, x-ray angiography, is invasive and only identifies late, structural changes in vessels. Recently, non-invasive imaging methods have shown promise in the assessment of patients with TA.”

The investigators reviewed invasive and noninvasive imaging performed on all patients in the rheumatology department at the Hammersmith Hospital between May 1996 and May 2002 who fulfilled the American College of Rheumatology criteria for TA. When diagnosed with TA, all patients had clinically active disease and were treated with high-dose oral prednisolone and additional oral or intravenous immunosuppressive therapy. Noninvasive imaging studies were [18F]fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) and magnetic resonance imaging (MRI).

Compared with x-ray angiography, [18F]FDG-PET provided important additional information about disease activity, and MRI provided important additional information about progression of vessel wall thickening.

The authors note that some previous magnetic resonance angiography studies have reported overestimation of the degree of stenosis by up to 15%. The presence or absence of gadolinium enhancement of the vessel wall on MRI was not a reliable guide to disease activity, and the presence or absence of vessel wall edema in MR images did not always correlate with anatomical changes found by conventional angiography. In this study, the presence or absence of [18F]FDG uptake in the vessel wall on PET imaging was a better indicator of disease activity.

“Non-invasive imaging methods provide useful additional information towards the diagnosis and management of TA. Such techniques may allow earlier diagnosis and more accurate assessment of response to treatment than conventional clinical assessment and/or angiography,” the authors write, while recommending further larger clinical studies. “Non-invasive imaging is likely to be useful in the management of other large vessel vasculitides.... In the future, [18F]FDG-PET and MRI may become the standard investigations performed when the diagnosis of TA is being considered and may ultimately replace the need for intra-arterial angiography in most patients.”

Ann Rheum Dis. 2004;63:995-1000

Reviewed by Gary D. Vogin, MD

    



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