[Magnetic resonance angiography in inflammatory brain diseases]
S Felber1, A Auer, E Schmutzhard
1Klinische Abteilung für Radiologie II, Universitätskliniken für Radiologie, Universitätskliniken Innsbruck, 6020 Innsbruck/Osterreich. stefan.felber@uibk.ac.at
Abstract:
In this review, we discuss the diagnostic potential of time of flight (TOF) MRA and contrast enhanced (CE) MRA in inflammatory disorders of the meninges and the brain. Cerebrovascular complications are frequently observed during infectious meningoencepalitis. 3D TOF-MRA and CE-MRA are complementary for the detection of basal intracranial artery stenosis and septic cerebral vein and sinus thrombosis due to secondary vasculitis. MRA reveals stenosis and occlusion as indirect signs of vasculitis, whereas MRI shows the inflammation of the brain and meninges and occasionally the vessel wall, together with the ischemic or hemorrhagic complication. In case of septic emboli MRA can detect peripheral occlusions and "mycotic" aneurysms. For the diagnosis of noninfectious vasculitides of the intracranial vessels, high resolution 3D TOF-MRA is superior to CE-MRA for the detection of multiloculated segmental stenoses. However, there are presently no prospective studies on the sensitivity and specificity of MRA for these indications. Therefore, only positive MRA results can directly influence clinical management. In case of normal MRA, confirmation by catheder angiography may still be required.
Insights
Time of flight (TOF) MRA and contrast-enhanced (CE) MRA are valuable for diagnosing inflammatory brain and meningeal disorders. These MRA techniques help detect cerebrovascular complications like stenosis and thrombosis, guiding clinical management.
Area of Science:
- Neuroradiology
- Neuroinflammation
- Vascular Imaging
Context:
- Inflammatory disorders affecting the meninges and brain often lead to cerebrovascular complications.
- Infectious meningoencephalitis frequently presents with secondary vasculitis, impacting intracranial vessels.
- Distinguishing between infectious and non-infectious intracranial vasculitis is crucial for appropriate patient management.
Purpose:
- To review the diagnostic utility of time of flight (TOF) MRA and contrast-enhanced (CE) MRA in inflammatory meningeal and brain disorders.
- To evaluate the complementary roles of 3D TOF-MRA and CE-MRA in detecting specific cerebrovascular complications.
- To assess the effectiveness of MRA in diagnosing both infectious and non-infectious intracranial vasculitis.
Summary:
- 3D TOF-MRA and CE-MRA are complementary tools for identifying basal intracranial artery stenosis and septic cerebral vein/sinus thrombosis.
- MRA detects indirect signs of vasculitis such as stenosis and occlusion, while MRI visualizes inflammation and complications.
- High-resolution 3D TOF-MRA is superior for detecting segmental stenoses in non-infectious intracranial vasculitis, though further validation is needed.
Impact:
- Positive MRA findings can directly influence clinical management decisions for patients with suspected vasculitis.
- MRA aids in the early detection of peripheral occlusions and mycotic aneurysms in cases of septic emboli.
- Further prospective studies are required to establish the definitive sensitivity and specificity of MRA for these indications.
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