The Value Of Ultrasounic Multimodality Imaging In Evaluating Vessels In Patients With Takayasu Arteritis

Objective: Takaysu arteritis(TAK)is a rare,chronic,nonspecific autoimmune disease that is one of the main causes of large vessel vasculitis(LVV),which mainly affects the aorta and its primary branches and pulmonary artery.It is more common in younger women.Childhood-onset takayasu arteritis(c-TA)has a poor prognosis.Timely hormone therapy is one of the keys to improving the prognosis of TAK,and the choice of drug dosage and timing of discontinuation often depends on whether TAK patients are in active period.So the accurate evaluation of TAK activity is particularly important for patients.At present,there is no unified standard for the diagnosis and activity of TAK in clinical practice,which mostly depends on clinical laboratory indicators and typical symptoms.With the development and advancement of medical equipment,imaging has gradually become one of the important means of diagnosis.Contrast-enhanced ultrasound(CEUS)and superb micro-vascular imaging(SMI)greatly improve the accurate diagnosis of diseases.The diagnosis of cervical blood vessels has been fully recognized and applied clinically.However,there are few studies on abdominal vascular activity,particularly in the assessment of TAK activity.In summary,this study aims to explore the diagnostic efficacy of ultrasound multimodality imaging methods in abdominal TAK,systematically evaluate TAK patients.The purpose of the second part is to assess disease activity in TAK with ultrasound multimodality combined with computerized tomography angiography(CTA).The objective of the last part is to screen for independent risk factors,establish and verify the prediction model to assess disease activity in TAK.The study provides a basis and method for the implementation of clinical diagnosis,treatment integration and the evaluation of patient prognosis.Methods: This study is prospective,and all patients participating in the study signed an informed consent form.From January 2019 to December 2022,TAK patients who visited Shengjing Hospital affiliated to China Medical University were recruited.In the first part,22 patients with abdominal blood vessels injured,who underwent CTA and ultrasound multimodality at the same time,were enrolled.The patients’ clinical information,laboratory indicators and imaging indicators(include 110 blood vessels)were recorded.Intergroup comparisons were performed using chi-square test or Fisher for the categorical variables or t-test or rank sum test for continuous variables.Taking the CTA diagnosis results as the gold standard,the ROC curve of the subject was drawn.The area under the curve(AUC)was calculated.The Z test compared the differences of different AUCs to evaluate the diagnostic efficacy of ultrasound multimodality in abdominal TAK.In the second part,1.a total of 92 patients were included,who underwent ultrasound multimodality.According to the NIH criteria,all TAK patients were divided into active and inactive groups.The two-dimensional ultrasound measurement of the tube wall thickness,blood flow velocity and other parameters,ultrasonic multimodality measured qualitative analysis data were recorded.The semi-quantitative analysis was evaluated the situation of neovascularization by observation of the amount of contrast agent into the thickened tube wall.The degree of neovascularization in the wall was divided into three grades(0-2 grade)as follows: grade 0,no contrast microbubbles in the lesion;grade 1,limited to moderate visualiztion of moving contrast microbubbles;grade 2,severe diffuse and moving contrast microbubbles.At the same time,quantitative analysis was carried out: the region of interest on the wall and in the lumen.The results focused on the most severely involved artery lesions where the visualization of moving microbubbles most.The software would automatically generate time-intensity curves.A1 and A were recorded respectively,and their ratio(A1/A)was calculated.Statistically distinct parameters was obtained by univariate analysis.Logistic regression was used to obtain predicted values.Based on the predicted values,the ROC curves of each index and ultrasound multimodality combining with multi-index were draw to calculate their AUC,sensitivity and specificity.The diagnostic efficacy of ultrasound multimodality assess the disease activity in TAK.2.a total of 54 patients who underwent CTA and ultrasound multimodality were selected,and the patients were divided into two groups,active and inactive.The delay-enhancement ring in CTA is recorded.The CT value of the thickening of the tube wall is delineated,which is recorded as CT1.The CT value of the paraspinal muscle is delineated at the same time,which is recorded as CT,and its ratio is calculated.The same statistical metheds are used.The diagnostic efficacy and clinical application value of ultrasound multimodality combined with CTA for TAK activity were evaluated.In the third part,92 patients who completed ultrasound multimodality were included.General information,laboratory indicators and values of ultrasonic multimodal parameters were recorded.According to NIH scoring standard,patients were divided into two groups: active and inactive.Patients were assigned to training group and test group in a 7:3 ratio.The training group was used for the development of the predictive model,and the test group used to verify the model.Variables that were statistically significant in the univariable logistic regression analyses were selected for multivariable stepwise logistic regression analysis.The ROC curve was outlined and the AUC calculated.The H-L test compared the AUC difference between the training group and the test group,and evaluates the prediction accuracy of the prediction model.The decision curve was used to evaluate the clinical application value of the model.The calibration curve estimated the calibration capability of the predictive model.The internal quintuple cross-validation evaluated the training effect of the model and obtains the best cut-off value of the model.The accuracy,sensitivity and specificity of the model were also assessed.Finally,the OR values of each independent risk factor are used to construct a nomogram.The nomogram was used to predict disease activity in TAK.Results: In the first part,boys with c-TA was significantly higher than men with TAK.In terms of symptoms,adults mostly went to hospital with typical symptoms of TAK(such as fever,claudication,vascular bruit and so on),and the proportion was significantly higher than that of children.However,children had more ischemic symptoms than adults.Vascular lesions in the abdominal aorta and its branches resulted in hypertension,changes in bowel habits and so on Compared with CTA,there was no significant difference in the measurement of the thickness of the arterial wall and the width of the blood flow at the narrowest part.The outer diameter of the lumen measured by CTA was significantly greater than that by ultrasonic multimodality The diagnostic efficiency of c-TA was the highest.But only the diagnostic efficacy of ultrasound multimodality in all TAK patients was statistically significantly higher than that of conventional ultrasound.In the second part,1.92 patients underwent ultrasonic multimodality were enrolled.45 patients had active disease and 47 patients showed inactive disease.The artery wall thickness,A1,A1/A and semi-quantitative measurements were statistically significant between the two groups.The AUC,which was 0.976,of ultrasonic multimodal multi-index combination was the largest.And it was statistically different.2.a total of 54patients underwent CTA and ultrasound multimodality.29 patients had active disease and25 had inactive disease.Artery wall thickness,A1,A1/A and semi-quantitative and CT1/CT were statistically significant between the two groups.Although the AUC diagnosed by ultrasound multimodality and CTA was larger than that of ultrasound multimodality,there was no significant statistical difference between the two groups.In the third part,semi-quantitative,A1/A and artery wall thickness were obtained as independent risk factors for disease activity in TAK through univariate analysis and multivariate analysis.The prediction model and nomogram were constructed.In the H-L test of the training group,P=0.102,the area under the ROC curve was 0.985,and the sensitivity,specificity,positive predictive value,negative predictive value were greater than 0.9.They indicated the calibration ability and prediction ability were better.The calibration curve and decision curve of the test group indicated that the model had good calibration ability and prediction ability.Conclusion: Ultrasound multimodality imaging had high diagnostic performance for abdominal artery lesions of TAK.It could be applied to the systematic evaluation of arteries involvement in patients with TAK except thoracic aorta,especially for patients who need regular follow-up.Ultrasound multimodality diagnosis was highly effective in assessing the degree of artery lesions and disease activity in TAK.With high diagnostic efficiency it could provide more imaging information,which is an essential feature for clinical application value.Combined with CTA,the scope of artery lesions could be comprehensively assessed.And then the activity and severity could be accurately diagnosed.The prediction model of disease activity in TAK had good prediction and clinical application ability.It could be an effective tool for identifying activity TAK.