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Intracranial ossifications and microangiopathy at 8 Tesla MRI
V Novak1, A Abduljalil, A Kangarlu
1Department of Neurology, The Ohio State University, Columbus, Ohio 43210, USA. vnovak@caregroup.harvard.edu
Unlabelled:
Clinical evaluation and MR imaging of microangiopathy associated with hypertension is limited. We describe a case that illustrates sensitivity of MRI at 8 Tesla for imaging of microvasculature, iron, calcium deposits and silent white matter lesions (WML). A 60-year-old black hypertensive woman was evaluated for numbness in the face and extremities. MRI at 1.5 Tesla was unrevealing.MRI at 8 Tesla: Axial and sagittal Gradient Echo images were obtained with an 8T/80 cm human scanner and showed: 1) Large areas of signal voids due to ossifications and fat deposits within the falx. 2) Obstructed small vessels in the periventricular regions and distended cortical veins. 3) Numerous small WML, suggestive of mini-infarcts (<1 cm) and microhemorrhages. 4) Intracranial calcifications in the falx, tentorium, basal ganglia and chorioid plexus that were confirmed by CT scan. Atherosclerotic plaque in right carotid artery and reduced vasomotor reserve in middle cerebral arteries, documented by ultrasound, indicated large and small vessel disease.
Conclusions:
MRI at 8 Tesla improves visualization of microangiopathy, ossifications and iron deposits due to enhanced magnetic susceptibility at ultra high magnetic field.
Insights
Ultra-high field MRI at 8 Tesla significantly enhances visualization of microvascular changes, calcifications, and iron deposits in hypertensive patients. This advanced imaging reveals subtle signs of microangiopathy missed by standard MRI, improving diagnostic accuracy.
Area of Science:
- Neuroimaging
- Cardiovascular Imaging
- Magnetic Resonance Imaging
Background:
- Clinical evaluation and standard Magnetic Resonance Imaging (MRI) at 1.5 Tesla have limitations in visualizing microangiopathy associated with hypertension.
- Hypertension-related microvascular disease affects small vessels, potentially leading to silent white matter lesions (WML) and microhemorrhages.
Observation:
- A case study involving a 60-year-old hypertensive woman with neurological symptoms presented with unrevealing standard MRI findings.
- Advanced MRI at 8 Tesla was employed to investigate potential microvascular abnormalities.
Findings:
- 8 Tesla MRI revealed signal voids from ossifications and fat deposits in the falx, obstructed periventricular small vessels, and distended cortical veins.
- Numerous small WML, suggestive of mini-infarcts and microhemorrhages, were identified.
- Intracranial calcifications in the falx, tentorium, basal ganglia, and chorioid plexus were confirmed, alongside atherosclerotic plaque and reduced vasomotor reserve.
Implications:
- Ultra-high field MRI at 8 Tesla demonstrates superior sensitivity for imaging microvasculature, iron deposits, and calcifications.
- Enhanced magnetic susceptibility at ultra-high fields improves visualization of microangiopathy, ossifications, and iron deposits, aiding in the diagnosis of complex cerebrovascular conditions.