Intracranial vessel wall imaging: applications, interpretation, and pitfalls.

Area of Science:

• Radiology
• Neurology
• Vascular Imaging

Background:

• Conventional vascular imaging focuses on the vessel lumen.
• Vessel wall imaging (VWI) shifts analysis to the vessel wall itself.
• Technical advancements are increasing VWI's clinical utility.

Purpose of the Study:

• To review the principles and applications of VWI.
• To discuss common imaging findings and interpretation strategies.
• To highlight potential pitfalls in VWI analysis.

Main Methods:

• Review of current literature on VWI.
• Discussion of VWI principles and technical considerations.
• Synthesis of imaging findings for various cerebrovascular diseases.

Main Results:

• VWI is valuable for diagnosing intracranial atherosclerosis, dissection, vasculitides (PACNS, neurosarcoidosis), and vasculopathies (RCVS, moyamoya disease, radiation-induced arteriopathy).
• VWI aids in evaluating aneurysms and post-thrombectomy changes.
• Understanding common findings and potential pitfalls is crucial for accurate interpretation.

Conclusions:

• VWI is an evolving, non-invasive tool for comprehensive cerebrovascular assessment.
• The review provides a guide to VWI interpretation for diverse clinical scenarios.
• Awareness of VWI limitations and pitfalls enhances diagnostic accuracy.