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CNS small vessel vasculitis: Distinct MRI features and histopathological correlation
Kamble J Harsha1, Sujit A Jagtap2, Tirur R Kapilamoorthy1
1Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthpuram, Kerala, India.
Neurology India
|November 15, 2017
Summary
Magnetic resonance imaging (MRI) reveals distinct features for central nervous system (CNS) small vessel vasculitis. Linear SWI blooming and lace-like enhancement on MRI can help diagnose lymphocytic CNS vasculitis.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Central nervous system (CNS) vasculitis presents diagnostic and therapeutic challenges.
- Small vessel vasculitis is particularly difficult to diagnose with conventional angiography.
- Existing imaging features for small vessel vasculitis lack specificity.
Purpose of the Study:
- To identify and describe distinct magnetic resonance (MR) imaging features of CNS small vessel vasculitis.
- To differentiate small vessel vasculitis from large and medium vessel vasculitis using MR imaging.
- To correlate imaging findings with histopathological diagnoses.
Main Methods:
- Retrospective review of five histologically confirmed CNS small vessel vasculitis cases (January 2008 - July 2012).
- All patients underwent MR angiography; three also had digital subtraction angiography, with all showing normal results.
- MR imaging analysis focused on T2/FLAIR hyperintensities and susceptibility-weighted imaging (SWI) blooming patterns.
Main Results:
- Five patients (mean age 34.2 years) were analyzed.
- Lymphocytic vasculitis cases showed discrete T2/FLAIR hyperintense lesions with central SWI blooming (linear/lace-like pattern).
- T1-weighted contrast-enhanced images revealed subtle linear/lace-like enhancement; tuberculous vasculitis showed coarse granular SWI blooming.
Conclusions:
- Linear SWI blooming along small cerebral vessels is a key MR imaging feature.
- Lace-like enhancement on post-contrast T1-weighted sequences suggests lymphocytic CNS small vessel vasculitis.
- These specific MR imaging findings aid in diagnosing CNS small vessel vasculitis.
