Background: Microcirculation impairment is a cardinal feature of systemic sclerosis (SSc). Magnetic resonance angiography (MRA) has greatly improved the assessment of vascular lesions of the hand.
Objectives: Our aim was to evaluate hand vascular abnormalities in SSc using MRA.
Methods: Thirty eight successive SSc patients were compared to 7 healthy subjects and 7 rheumatoid arthritis (RA) patients. Mean±SD age for SSc patients was 52±14 years, disease duration 7±9 years, 10 had current digital ulcers. MRA consisted in 4 successive acquisitions lasting 50 seconds each of 3-dimensional coronal cross-sectional images after gadolinium injection. The primary criteria were: distality and quality of arterial opacification, avascular areas, venous flux.
Results: Thirty five (92 %) SSc patients had at least one true digital artery which did not reach the first phalanx at the initial arterial analysis and 23 (61 %) had four or more damaged arteries. Twenty eight (74 %) patients had thin arteries and 23 (61 %) had more than one avascular area. All the patients had abnormal venous flux and general venous blockage was found in 12 patients (32 %). All the controls had normal arterial and venous opacifications. The figure shows the results for a healthy subject (A), a patient with rheumatoid arthritis (B) and a patient with SSc (C). There was a relationship between vessel damage and digital ulceration or systolic pulmonary arterial pressure.


References: These results show the substantial specific vascular involvement in SSc. Lesions were diffuse and involved both arterial and venous vessels of small caliber and the microcirculation. Hand MRA appears to be a promising non invasive tool to evaluate the vascular aspects of SSc.