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Published on: March 2, 2015
Black blood MRI in suspected large artery primary angiitis of the central nervous system
Thomas Pfefferkorn1, Jennifer Linn, Maximilian Habs
1Department of Neurology, University of Munich, Germany.
Objectives:
Single case reports suggest that black blood MRI (T1-weighted fat and blood suppressed sequences with and without contrast injection; BB-MRI) may visualize intracranial vessel wall contrast enhancement (CE) in primary angiitis of the central nervous system (PACNS). In this single-center observational pilot study we prospectively investigated the value of BB-MRI in the diagnosis of large artery PACNS.
Methods:
Patients with suspected large artery PACNS received a standardized diagnostic program including BB-MRI. Vessel wall CE was graded (grade 0-2) by two experienced readers blinded to clinical data and correlated to the final diagnosis.
Results:
Four of 12 included patients received a final diagnosis of PACNS. All of them showed moderate (grade 1) to strong (grade 2) vessel wall CE at the sites of stenosis. A moderate (grade 1) vessel wall CE grade was also observed in 6 of the remaining 8 patients in whom alternative diagnoses were made: arteriosclerotic disease (n = 4), intracranial dissection (n = 1), and Moyamoya disease (n = 1).
Conclusions:
Our pilot study demonstrates that vessel wall CE is a frequent finding in PACNS and its mimics. Larger trials will be necessary to evaluate the utility of BB-MRI in the diagnostic workup of PACNS.
Insights
Black blood MRI (BB-MRI) can visualize intracranial vessel wall enhancement in primary angiitis of the central nervous system (PACNS). However, this finding is also frequent in other cerebrovascular diseases, requiring further research.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Primary angiitis of the central nervous system (PACNS) is a rare condition affecting large arteries.
- Black blood MRI (BB-MRI) with contrast enhancement (CE) has shown potential in visualizing intracranial vessel walls.
Purpose of the Study:
- To prospectively investigate the diagnostic value of BB-MRI in large artery PACNS.
- To assess the frequency and significance of intracranial vessel wall CE in PACNS and its mimics.
Main Methods:
- A single-center observational pilot study included patients with suspected large artery PACNS.
- Patients underwent a standardized diagnostic program including BB-MRI.
- Vessel wall CE was graded by blinded readers and correlated with final diagnoses.
Main Results:
- Four out of 12 patients were diagnosed with PACNS, all showing moderate to strong vessel wall CE.
- Six of the remaining eight patients with alternative diagnoses (arteriosclerosis, dissection, Moyamoya) also exhibited moderate vessel wall CE.
Conclusions:
- Intracranial vessel wall CE is a common finding in both PACNS and its mimics.
- Larger studies are needed to confirm the utility of BB-MRI in diagnosing PACNS.
