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Großgefäßvaskulitiden

Bildgebung und interventionelle Therapie

Large-vessel vasculitis

Imaging and interventional therapy

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Zusammenfassung

Primäre Großgefäßvaskulitiden sind die Riesenzellarteriitis (Arteriitis temporalis) und die Takayasu-Arteriitis. Bei ihnen führen entzündliche Zellinfiltrationen und Zytokine zu Destruktionen und Hyperplasien der Gefäßwand mit der möglichen Folge von Stenosen oder Aneurysmen. Bei Befall der extrakraniellen großen Arterien findet sich oft ein ähnliches klinisches und radiologisches Bild im Sinne eines entzündlichen Aortenbogensyndroms. Seltenere Ursachen einer Großgefäßvaskulitis sind der Morbus Behçet, die Assoziation mit einer anderen Autoimmunerkrankung oder eine infektiöse Genese. Die bildgebende Diagnostik der Großgefäßvaskulitiden erfolgt in Abhängigkeit von der Lokalisation mittels Duplexsonographie, Magnetresonanztomographie, Computertomographie und Positronenemissionstomographie. Neben der initialen Diagnosestellung dienen diese Verfahren auch der Erfassung der Krankheitsausdehnung, der Aktivitätsbestimmung sowie der Verlaufskontrolle unter medikamentöser Therapie. Mit der intraarteriellen Angiographie können Stenosen und Verschlüsse interventionell-radiologisch saniert werden.

Abstract

Giant cell arteritis and Takayasu’s arteritis are classified as primary large-vessel vasculitides. Inflammatory cell infiltrates and cytokines induce destruction and hyperplasia of the vessel wall, leading to stenoses or aneurysms. When extracranial large arteries are involved, there is often a similar clinical and radiologic disease pattern of an inflammatory aortic arch syndrome. Rare causes of large-vessel vasculitis include Behçet’s disease, association with other autoimmune diseases, and infection. Depending on the localization, imaging is usually performed by means of duplex ultrasound, magnetic resonance imaging, computed tomography, or positron emission tomography. These imaging modalities are used not only to establish the diagnosis but also to determine the disease extent and activity and to perform follow-up in the course of medical therapy. Angiography offers the option to perform interventional therapy for vascular stenoses and occlusions.

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  1. Klinik für Diagnostische Radiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 9, 24105, Kiel, Deutschland

    M. Both & M. Heller

  2. Rheumaklinik Bad Bramstedt und Poliklinik für Rheumatologie, Universitätsklinikum Schleswig- Holstein, Campus Lübeck, Lübeck, Deutschland

    F. Moosig & W.L. Gross

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  1. M. Both
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Both, M., Moosig, F., Gross, W. et al. Großgefäßvaskulitiden. Radiologe 49, 947–966 (2009). https://doi.org/10.1007/s00117-008-1817-4

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