Application of conventional ultrasound‐based carotid grading system in assessing disease activity and monitoring progression in Takayasu arteritis

OBJECTIVE: This study aimed to evaluate and validate the utility of a conventional ultrasound-based carotid grading system in assessing disease activity in Takayasu arteritis (TA) with carotid artery involvement, distinguishing between active and inactive patients, and monitoring therapeutic response. METHODS: The 108 patients were classified into the clinically-active group (CAG) and the clinically-inactive group (CIG), and were further classified into Grades I-V according to carotid ultrasound imaging characteristics, with Grades I, II, and V categorized as the ultrasound-active group (UAG), and Grades III and IV as the ultrasound-inactive group (UIG). Intergroup differences were compared, and the diagnostic performance of the ultrasound grading system for disease activity was evaluated by the ROC curve analysis. Treatment response assessed in 68 follow-up patients based on ultrasound grading. RESULTS: The CAG exhibited higher inflammatory markers and greater carotid wall thickness (p < 0.05). Grades I, II, and V predominated in the CAG, whereas Grades III and IV were more frequent in the CIG. Compared to the UIG, the UAG showed significantly elevated ESR, CRP, C3, and IgM, and thicker carotid walls (p < 0.05). The ultrasound grading system achieved an AUC of 0.710 for identifying clinical activity in TA. Combined with carotid wall thickness, diagnostic performance surpassed either parameter alone. Among 68 follow-up patients, the UAG had higher inflammatory markers and greater wall thickness at baseline but demonstrated more pronounced improvement in disease activity after treatment. CONCLUSIONS: Conventional ultrasound is a reliable tool for characterizing vascular wall inflammation and monitoring therapeutic response in TA patients with carotid artery involvement.