1. Imaging of vasculitis
Dr/Ahmed Bahnassy
Consultant Radiologist
PSMMC

2. WHAT IS VASCULITIS?
• Vasculitis is a clinicopathologic
process characterized by inflammation
and damage to blood vessels,leading
to compromise of the vascular lumen
resulting in ischemia of the tissues
supplied by the involved vessels.

3. 3
pathogenesis
• Immune complex production &
deposition
• Production of ANCA
• T-Lymphocyte response and
granuloma formation
group of autoantibodies, mainly IgG ,
detected in autoimmune disorders,
particularly systemic vasculitis

4. Pathological
process

5. Steps of thinking
1.Which vessels are affected ?
arteries,veins ,or both.
2.which arteries are affected?
Large,medium or small sized.
3.How vessels are affected?
stenosis ,occlusion ,aneurysm
venous thrombosis (acute or chronic)
4.what secondary effects of vascular affection are
present?
e.g.: infarction,bowel ischaemia

6. 5.Look in other sites for syndromic vasculitis
e.g. :Lungs (wegener granulomatosis).
6.Estimate disease activity
Ultrasound (( ffoorr aacccceessiibbllee aarrtteerriieess..
CCTT
MMRRII
PPEETT

7. Differential diagnosis

8. Large vessel vasculitis
• Giant cell arteritis
• Takayasu’s arteritis

9. Medium vessel Vasculitis
• Poly Arteritis Nodosa
• Kawasaki’s vasculitis

10. Small vessel Vasculitis
Pauci-immune (ANCA mediated)
Wegener’s Granulomatosis
Churg Strauss vasculitis
Microscopic Polyangiitis
Immune complex mediated
Henoch Schonlein Purpura
Essential Mixed Cryoglobulinemia
SLE and other collagen c=vascular diseases
related vascultis

11. Other primary vasculitides
• Thromb Angiitis Obliterans
• Behcet’s disease
• Idiopathic Cutaneous vasculitis
• Isolated Vasculitis of CNS
• Relapsing Polychondritis
• Polyangiitis overlap syndromes (features
of more than 1 vasculitis)

12. Giant cell arteritis
• Temporal arteritis
• Elderly persons more than 50 yrs. of age
• Non specific symptoms, Headache,
Elevated ESR
• BLINDNESS-most serious complication
• Jaw claudication, Scalp pain, Scalp
Tenderness
• Polymyalgia Rheumatica.

13. Takayasu’s Arteritis
• Pulseless Disease
• Middle aged females
• Aorta and its branches mainly involved
• Subclavian vessels, Carotid vessels,
Mesentric vessels
• Chronic and Relapsing course

14. Poly Arteritis Nodosa
• Renal arteries most commonly involved
leading to renovascular hypertension
• Pulmonary vessels NEVER involved
• Association with patients of
o Hepatitis B
o Hairy cell leukemia

15. Kawasaki’s Vasculitis
• MucoCutaneous Lymph node
syndrome
• Children < 5 years of age
mostly
• Desquamative erythematous
rashes involving the skin,
mucus membranes, cervical
lymphadenopathy
• 25 % develop coronary artery
aneurysms in the convalescent
stage of the illness

16. Pauci immune Vasculitis
Usually Pulmonary capillaritis PLUS
Glomerulonephritis
•Granulomas +, Asthma +  Churg Strauss
•Granulomas +, NO asthma  Wegener’s
•NO granulomas, NO asthma 
Microscopic Polyangiitis

17. Wegener’s Granulomatosis
• Chronis sinusitis, Pulmonary nodules,
Pulmonary cavities, Rapidly Progressive
Glomerulonephritis
• Cutaneous vasculitis, Eye lesions may be
present
• Non specific symptoms may predominate

19. Churg Strauss Vasculitis
• Asthma, Eosinophilia with pulmonary
infiltrates , glomerulonephritis
• Myocardial involvement  most common
cause of death
Microscopic Polyangiitis
• Pulmonary alveolar capillariitis,
glomerulonephritis

21. Henoch Schonlein Purpura
• 2nd decade
• Palpable purpura over
lower limbs,
• Gastrointestinal
complaints (abd.colicky
pain, blood in stools),
• Fever, polyarthralgia
• Increased IgA levels in
blood

22. role of imaging ?

23. Essential Mixed Cryoglobulinemia
• 5 % of Chronic Hepatits C pts. Have EMC
• Cryoglobulins formed agianst HCV RNA
• Pulmonary, renal ( MPGN ), cutaneous
vasculitis

24. Thromb Angiitis Obliterans
• Chronic heavy Smokers
• Inflammation of arteries, veins, nerves
• Upper and lower limb gangrene, Instep
claudication, rest pain

26. Other primary vasculitides
• Behcet’s disease (Recurrent
OculoOroGenital ulcerations with
vasculitis)

27. Other primary vasculitides
• Idiopathic Cutaneous vasculitis
• Isolated Vasculitis of CNS
• Relapsing Polychondritis
• Polyangiitis overlap syndromes (features
of more than 1 vasculitis)

28. Pearls in requesting
imaging study
Angiography is useful in demonstrating vessel lumen alterations such
as stenoses or aneurysms. However, it is unable to reveal initial
vasculitic lesions such as vessel wall oedema and thickening, and is
thus not useful to diagnose vasculitis early.

29. CDS, CT angiography, MRI and MRA are
able to delineate both the vessel wall
and the lumen. Therefore, they can reveal
vessel wall alterations when the lumen is
still unaffected on angiography

30. 18 FDG PET does not
delineate the vessel wall,
but is very sensitive in
revealing
vessel wall inflammation.
It is particularly useful to
make a diagnosis and
disclose the extent of
large vessel vasculitis, as
well as to monitor the
disease course.

31. other pearls
Not every vessel with active disease on
imaging will develop structural changes
Vessels that appear to be unaffected on
imaging at a given time may still develop
alterations at a later stage
CT is the investigation of choice for
demonstrating lung lesions
MRI is the most appropriate technique to
study brain involvement
MRI has shown promising results in the
evaluation of muscle disease