Shear wave elastography combined with serum IL-6 and MMP-9 for evaluating disease activity in Takayasu arteritis with carotid artery involvement.

objectiveThis study aimed to combine shear wave elastography (SWE) with serum interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9) for evaluating disease activity in patients with Takayasu arteritis (TAK) with carotid artery involvement.

methodsA total of 63 patients clinically diagnosed with TAK were recruited from our institutions and were stratified into an active disease group (Group A, n = 35) and an inactive disease group (Group B, n = 28). Additionally, 30 healthy individuals were recruited as controls (Group C). Demographic characteristics and biochemical parameters were collected from all three groups, and treatment information was recorded for the enrolled patients. Serum levels of IL-6 and MMP-9 were quantified. Conventional ultrasound was performed to assess intima-media thickness (IMT), extra-media thickness (EMT), and full-wall thickness (FWT) of the carotid artery. SWE was subsequently employed to obtain the SWE values, including the maximum (MEmax), mean (MEmean), and minimum (MEmin) elastic modulus of the intima-media, extra-media, and full-wall layers of the anterior wall of the common carotid artery in the participants.

resultsNo significant differences were found in gender, age, heart rate, smoking status, or white blood cell (WBC) counts among the groups (all p > 0.05). There were no significant differences between groups A and B in the prevalence of hypertension or in the proportion of patients receiving each class of medications (all p > 0.05). Groups A and B demonstrated higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), IL-6, and MMP-9 compared with Group C (all p < 0.05), and Group A presented higher levels than Group B (all p < 0.05). Similarly, IMT, EMT, and FWT were higher in Groups A and B relative to Group C, and values in Group A were higher than those in Group B (all p < 0.05). Intima-media SWE (IM-SWE) values and full-wall SWE (FW-SWE) values were higher in Groups A and B than in Group C (all p < 0.05). IM-SWE, extra-media SWE (EM-SWE), and FW-SWE values were higher in Group A compared with Group B (all p < 0.05). In the patient groups, SWE values decreased from extra-media to full-wall to intima-media (all p < 0.05). In TAK patients, correlation analysis revealed that IM-SWE, EM-SWE, and FW-SWE values exhibited positive correlations with ESR, CRP, IL-6, MMP-9, IMT, EMT, and FWT. In the multiple linear regression analysis with SWE values as the dependent variable, disease activity was independently associated with SWE values after adjustment for age, gender, hypertension, heart rate and smoking status (all β > 0.54, all p < 0.01). The combined model of SWE values with IL-6 and MMP-9 levels yielded an AUC of 0.935 for diagnosing active disease of carotid involvement in TAK, outperforming any single parameter.

conclusionThe combination of SWE values with serum IL-6 and MMP-9 provides an accurate method for determining disease activity in TAK with carotid artery involvement. Key Points • Shear wave elastography enables non-invasive, real-time, quantitative assessment of carotid arterial wall elasticity in both active and inactive Takayasu arteritis. In patients with active disease, SWE values of the intima-media, extra-media, and full-wall layers were significantly higher than in patients with inactive disease. • The combination of SWE with serum IL-6 and MMP-9 levels provides a valuable approach for assessing disease activity in patients with TAK with carotid artery involvement. This integrated method can offer reliable evidence to inform clinical diagnosis and guide treatment decisions.