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Vessel wall MR imaging of central nervous system vasculitis: a systematic review

Nathan Arnett1, Athanasios Pavlou2, Morgan P Burke2

  • 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Neuroradiology
|May 3, 2021
PubMed

Insights

Vessel wall MRI (VW-MRI) reveals distinct patterns for inflammatory and infectious vasculitis in the central nervous system (CNS). Understanding these imaging biomarkers is crucial for diagnosing CNS vasculitis.

Area of Science:

  • Neurology
  • Radiology
  • Immunology

Background:

  • Central nervous system (CNS) vasculitis diagnosis relies on understanding vessel wall magnetic resonance imaging (VW-MRI) features.
  • Limited knowledge exists regarding specific VW-MRI findings beyond vessel wall enhancement in CNS vasculitis.

Purpose of the Study:

  • To review and compare VW-MRI patterns of inflammatory versus infectious vasculitis.
  • To compare VW-MRI patterns between intracranial and extracranial arteries in the head and neck.

Main Methods:

  • Systematic literature search of PubMed, Scopus, Cochrane, Web of Science, and EMBASE up to June 10, 2020.
  • Inclusion of 115 studies reporting CNS/head and neck vasculitis with MR imaging descriptions of vessel wall features.
  • Extraction of data on study characteristics, vasculitis type, MR details, and VW-MRI findings.

Main Results:

  • VW-MRI was utilized for inflammatory (64%), infectious (17%), and mixed vasculitides (19%).
  • Common findings included vessel wall enhancement (89%) and thickening (72%).
  • Inflammatory intracranial vasculitis showed less thickening and perivascular enhancement than extracranial counterparts. Varicella zoster/herpes simplex vasculitis (VZV/HSV) demonstrated better treatment response on imaging than primary angiitis of the CNS (PACNS).

Conclusions:

  • VW-MRI features vary based on vasculitis mechanism and arterial location (intracranial vs. extracranial).
  • Further understanding of these VW-MRI patterns is essential for developing imaging biomarkers for CNS vasculitis.
  • Distinguishing between infectious and inflammatory vasculitis and their anatomical distribution is key for accurate diagnosis and management.
Abstract

Keywords:
BiomarkerCentral nervous systemMagnetic resonance imagingVasculitisVessel wall MR imaging

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