Characteristics and clinical significance of aortic ulcer signs on computed tomography angiography in patients with Takayasu's arteritis

OBJECTIVES: To explore the clinical and disease characteristics associated with aortic ulcers signs on computed tomography angiography (CTA) in patients with Takayasu's arteritis (TAK). METHODS: We retrospectively analysed CTA scans from consecutive TAK patients at Xijing Hospital between 2021 and 2025. We identified aortic ulcers and recorded their location, transverse diameter, and depth. Clinical, laboratory, and imaging data were compared between ulcer and non-ulcer groups. Multivariate regression analysed independent risk factors for ulcers. RESULTS: The prevalence of aortic ulcers was 7.6% (27/355) among overall screened TAK patients. Of 200 hospitalised patients in this study, 26 (13.0%) exhibited signs of aortic ulcers. Ulcers were predominantly located in the thoracic aorta, aortic arch, and left common carotid artery, with a median transverse diameter of 3.4 mm and a depth of 2.4 mm. The ulcer group demonstrated significantly higher rates of Numano V (69.2% vs. 40.8%, p=0.007), aortic regurgitation (52.4% vs. 21.8%, p=0.003), and T-SPOT TB positivity (43.5% vs. 19.2%, p=0.01). No significant differences in disease activity scores or most inflammatory markers were observed. Numano V was identified as an independent risk factor for the presence of aortic ulcers (OR 3.45, 95% CI 1.38-8.61, p=0.008). Follow-up CTAs in 5 patients indicated stable ulcer size despite vascular progression. CONCLUSIONS: In TAK patients, aortic ulcers were independently associated with Numano V, but not with current systemic activity, suggesting they may represent chronic structural sequelae. Long-term monitoring is essential to reduce the risks of complications.