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Vascular ❯ Vasculitis

ProblemEvaluation for suspected vasculitis
ProtocolA CTA of the neck, chest, abdomen and pelvis is done with thin section CT and an injection rate of 5cc/sec for a volume of 120 cc. Reconstruction use a standard algorithm for soft tissue and the images are reviewed with axial, Multiplanar and 3D imaging. Focused reconstructions over the vascular map like the carotid arteries, branch vessels off the arch as well as renal arteries and mesenteric arcade are done. MIP imaging and Cinematic Rendering (CR) are especially valuable to detect subtle changes in the vessels.
Pearls1.    The differential of vasculitis will often be described as large vessel disease and small and medium vessel disease
2.    Changes in the vessels can range from wall thickening with vessel stenosis to aneurysm/pseudoaneurysm to vessel stenosis and to vessel beading
3.    The specific vasculitis will usually involve select vessels. For example FMD (fibromuscular dysplasia) will commonly involve the carotid and renal arteries. The subclavian artery is commonly involved in Takayasu’s aortitis and in Kawasaki’s disease the classic site of involvement is the coronary arteries. PAN most commonly involves the renal arteries
4.    For the mesenteric vessels review with thin slab MIP is ideal. Cinematic rendering is especially helpful when looking at large vessels like the iliac vessels for beading.
5.    Perfusion changes in organs like the kidney are often helpful signs

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