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High-Resolution Vessel Wall Imaging in Primary Angiitis of Central Nervous System
Soumya Sundaram1, P Naveen Kumar1, Dev Prakash Sharma2
1Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Insights
High-resolution vessel wall imaging (HRVWI) reveals characteristic patterns in primary angiitis of the central nervous system (PACNS). Concentric vessel wall thickening and enhancement are common findings, suggesting HRVWI as a valuable diagnostic tool for PACNS.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- High-resolution vessel wall imaging (HRVWI) is underutilized in diagnosing primary angiitis of the central nervous system (PACNS).
- HRVWI has the potential to differentiate various intracranial vasculopathies.
Purpose of the Study:
- To describe the specific vessel wall imaging characteristics of PACNS using HRVWI.
- To evaluate the utility of HRVWI in the diagnosis of PACNS.
Main Methods:
- Retrospective descriptive study of 21 patients with confirmed PACNS.
- Inclusion criteria: confirmed PACNS diagnosis and abnormal HRVWI.
- Assessment of vessel wall parameters including T1W/T2W appearance, wall thickening, enhancement, and remodeling index.
Main Results:
- HRVWI showed abnormalities in 95.2% of PACNS patients.
- Common findings included concentric vessel wall thickening (60%) and diffuse enhancement (85%).
- Affected vessels commonly included the proximal middle cerebral artery and internal carotid artery.
Conclusions:
- HRVWI demonstrates distinct vessel wall appearances in PACNS.
- Concentric thickening and enhancement are frequent findings.
- HRVWI is a potentially valuable noninvasive imaging modality for PACNS diagnosis.
Background:
High-resolution vessel wall imaging (HRVWI) can aid in differentiating the various intracranial vasculopathies, but has been sparingly used in the diagnosis of primary angiitis of central nervous system (PACNS). This study is aimed to describe the vessel wall imaging characteristics of PACNS.
Materials And Methods:
Patients with confirmed diagnosis of PACNS according to the Calabrese and Mallek criteria who had abnormal HRVWI were included in this retrospective descriptive study. Magnetic resonance image of brain, conventional four-vessel cerebral digital subtraction angiogram, and HRVWI were read by a neuroradiologist. The vessel wall parameters assessed were T1W and T2W appearances, pattern of wall thickening and contrast enhancement, and remodeling index.
Results:
HRVWI done in 21 patients with PACNS yielded abnormality in 20 (95.2%) who were included in the analysis. The mean age at presentation was 42.55 ± 9.48 years and 14 (70%) were males. The median number of vessels involved were four (range 2-12). The commonest vessels affected were proximal middle cerebral artery (70%) and internal carotid artery (55%). Vessel wall thickening was concentric, eccentric, and absent in 12 (60%), 1 (5%), and 7 (35%) patients, respectively. Vessel wall enhancement was diffuse in 17 (85%), eccentric in 1 (5%), and absent in 2 (10%) patients. One patient had T2W hyperintense stenotic lesion. Remodeling index was negative in 11 (55%) patients.
Conclusion:
Distinctive vessel wall appearances were observed by HRVWI in PACNS, concentric vessel wall thickening and enhancement being more frequent. Hence, HRVWI can be considered as an additional noninvasive imaging modality in the diagnosis of PACNS.
