Combined brain and heart magnetic resonance imaging in systemic vasculitides: fiction or real need?

Area of Science:

• Neurology and Cardiology
• Systemic Vasculitides (SVs)
• Neuroimaging and Cardiovascular Imaging

Background:

• Systemic vasculitides (SVs) involve blood vessel inflammation, potentially affecting multiple organs.
• Concurrent brain and heart involvement in SV significantly increases patient morbidity and mortality.
• Cerebral vasculitis (CV) presents with neurological symptoms, while cardiovascular disease (CVD) involves cardiac inflammation and dysfunction.

Purpose of the Study:

• To review evidence of simultaneous brain and heart involvement in systemic vasculitides.
• To evaluate the role of combined brain and heart magnetic resonance imaging (MRI) in risk stratification for SV patients.
• To highlight the clinical utility of advanced MRI techniques in diagnosing and managing complex SV cases.

Main Methods:

• Review of existing literature and clinical data on systemic vasculitides with brain and heart involvement.
• Assessment of magnetic resonance imaging (MRI) capabilities for detecting cerebral and cardiac lesions.
• Discussion of the current limitations and potential applications of combined brain/heart MRI in SV.

Main Results:

• MRI is effective in identifying brain lesions and cardiac inflammation/fibrosis non-invasively.
• Combined brain/heart MRI is recommended for SV patients with clinical suspicion of multi-organ involvement.
• High-risk patients (e.g., SLE/APS) with suspected CVD or stroke benefit from this imaging approach.

Conclusions:

• Combined brain and heart MRI offers valuable insights for risk stratification in systemic vasculitides.
• Despite limitations like cost and availability, MRI is crucial for diagnosing subtle or atypical presentations.
• Further clinical data is needed, but MRI is indicated in specific SV patient groups with suspected neurological and cardiac issues.