Smooth concentric wall thickening of the aorta and its branches with stenoses, occlusions and aneurysms in a young woman (Takayasu) or an older patient (giant cell arteritis) — early wall thickening and enhancement come before stenosis; the report maps every involved branch.
Orient first
- Takayasu: subclavian, carotid, renal and pulmonary arteries; young women, common in Asia (including India).
- Giant cell arteritis: older patients; thoracic aorta and axillary arteries.
- Active inflammation: wall oedema on MRI, enhancement, FDG uptake.
Acquire the study
- CT angiography from the neck to the pelvis, arterial and delayed phases.
The manoeuvre
- Arterial phase: concentric wall thickening in mm; double-ring enhancement on the delayed phase.
- Map stenoses, occlusions and aneurysms of each branch on MIP and curved reformats (Numano type — verify).
- Pulmonary and renal arteries on the arterial phase.
- Collaterals around occlusions.
What confirms it
- Typical wall thickening and branch disease with clinical classification criteria.
What licenses you to exclude it
- Normal aortic wall and branches on CTA/MRA exclude established large-vessel vasculitis.
The classic misread
- Calling mural thrombus or atheroma wall thickening.