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Value of second opinion subspecialty radiology consultation in suspected abdominal medium vessel vasculitis

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To perform a descriptive analysis of individuals with suspected Polyarteritis nodosa (PAN) referred for second opinion imaging consultation.

Methods

A retrospective observational cohort study was performed at a single institution. A consecutive sample was performed of individuals who underwent a second opinion CT or MR angiography subspecialty radiologist consultation between January 2008 and September 2019 for suspected abdominal medium vessel vasculitis. Demographic, clinical, and imaging data were collected. Clinical and imaging findings were reported for PAN, small vessel vasculitis, and “non-vasculitis” groups. Agreement and diagnostic accuracy between final clinical and second opinion imaging diagnoses for PAN were determined. Two-tailed t-tests with a significant p-value < 0.05 were utilized.

Results

Of the 58 participants, 9 were clinically diagnosed with PAN, 11 with small vessel vasculitis (including lupus, IgA, and ANCA-associated vasculitis), and 38 with non-vasculitis diagnoses. The non-vasculitis group included 15 SAM, 3 FMD, and 1 SAM-FMD spectrum diagnoses. Higher C-reactive protein level (51 vs 17, p = 0.04) and superior mesenteric artery involvement (56% vs 21%, p = 0.04) were more common in PAN than non-vasculitis diagnoses, while arterial dissection (40% vs 0%, p = 0.02) and celiac vasculature involvement (53% vs 0%, p = 0.003) were more common in the non-vasculitis group. There was 88% agreement (51/58; Cohen’s kappa 0.56); sensitivity was 67% [95%-confidence interval (CI) 30–93%] and specificity was 92% (95%-CI 80–98%).

Conclusion

Isolated celiac artery involvement and arterial dissection were more common in non-inflammatory vasculopathies than PAN. Our findings highlight the need for multidisciplinary collaboration and awareness of the diverse findings of abdominal vasculopathies.

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Data availability

Study data are available upon request.

Abbreviations

PAN:

Polyarteritis nodosa

SAM:

Segmental arterial mediolysis

FMD:

Fibromuscular dysplasia

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

PACS:

Picture and Archiving System

CRP:

C-reactive protein

ESR:

Erythrocyte sedimentation rate

RF:

Rheumatoid factor

Anti-CCP antibody:

Anti-cyclic citrullinated peptide

ANA:

Anti-nuclear antibody

ANCA:

Antineutrophil cytoplasmic antibodies

SMA:

Superior mesenteric artery

SD:

Standard deviation

IQR:

Interquartile range

95%-CI:

95% Confidence intervals

SLE:

Systemic lupus erythematosus

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Funding

No funding was provided for any component of the submitted work.

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Authors and Affiliations

  1. Department of Radiology, McMaster University, Hamilton, ON, Canada

    Mostafa Alabousi

  2. Division of Rheumatology, Department of Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada

    Mats Junek, Stephanie Garner & Nader Khalidi

  3. Department of Radiology, Diagnostic Imaging, St. Joseph’s Healthcare Hamilton, McMaster University, 50 Charlton Ave. E, Hamilton, ON, L8N 4A6, Canada

    Ryan Rebello

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  1. Mostafa Alabousi
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  2. Mats Junek
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  4. Nader Khalidi
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Contributions

All coauthors were involved in inception, data collection, preparation, and editing of this manuscript. The final manuscript has been reviewed and approved for submission by all coauthors involved.

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Correspondence to Ryan Rebello.

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There are no conflicts of interest or competing interests to disclose. The authors declare they have no financial interests or non-financial interests.

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Local institutional research ethics board approval was obtained for this study and the requirement for informed consent was waived prior to commencement (project number 8103).

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Alabousi, M., Junek, M., Garner, S. et al. Value of second opinion subspecialty radiology consultation in suspected abdominal medium vessel vasculitis. Abdom Radiol 46, 5763–5771 (2021). https://doi.org/10.1007/s00261-021-03277-4

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  • DOI: https://doi.org/10.1007/s00261-021-03277-4

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